Provider Demographics
NPI:1518510874
Name:CRAWFORD, GRETCHEN JO ANNE (RNP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:JO ANNE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 E 14TH ST APT 607
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-4562
Mailing Address - Country:US
Mailing Address - Phone:520-204-0859
Mailing Address - Fax:
Practice Address - Street 1:1925 W ORANGE GROVE RD STE 307
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1152
Practice Address - Country:US
Practice Address - Phone:520-792-2199
Practice Address - Fax:520-818-9992
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ105766163W00000X
AZ235295363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse