Provider Demographics
NPI:1447578711
Name:CRANE, DESIREE HANSEN (DO)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:HANSEN
Last Name:CRANE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 30180
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130-0180
Mailing Address - Country:US
Mailing Address - Phone:208-860-2441
Mailing Address - Fax:
Practice Address - Street 1:5121 S COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5701
Practice Address - Country:US
Practice Address - Phone:801-507-6600
Practice Address - Fax:801-442-0643
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12715207P00000X
OH34.010668207P00000X
UT9601876-1204207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine