Provider Demographics
NPI:1659139517
Name:CROWLEY, GEORGIA CLAIRE
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:CLAIRE
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-5123
Mailing Address - Country:US
Mailing Address - Phone:831-535-8220
Mailing Address - Fax:
Practice Address - Street 1:1205 FREEDOM BLVD UNIT 3B
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2777
Practice Address - Country:US
Practice Address - Phone:831-288-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker