Provider Demographics
NPI:1568662534
Name:ELAN, SEAHEART CRUMPTON (LMT-OR(ADD);LMP-WA(I)
Entity Type:Individual
Prefix:MS
First Name:SEAHEART
Middle Name:CRUMPTON
Last Name:ELAN
Suffix:
Gender:F
Credentials:LMT-OR(ADD);LMP-WA(I
Other - Prefix:MS
Other - First Name:DORIS
Other - Middle Name:CRUMPTON
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP-WA(INACTIVE)
Mailing Address - Street 1:PO BOX 2588
Mailing Address - Street 2:
Mailing Address - City:WALDPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97394
Mailing Address - Country:US
Mailing Address - Phone:541-563-8333
Mailing Address - Fax:360-385-2117
Practice Address - Street 1:539 MOFFITT ROAD
Practice Address - Street 2:
Practice Address - City:WALDPORT
Practice Address - State:OR
Practice Address - Zip Code:97394
Practice Address - Country:US
Practice Address - Phone:541-563-8333
Practice Address - Fax:360-385-2117
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010469174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist