Provider Demographics
NPI:1679076376
Name:CRANE, OLIVIA CATHERINE
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:CATHERINE
Last Name:CRANE
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 1:7302 177TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MN
Mailing Address - Zip Code:55025-8875
Mailing Address - Country:US
Mailing Address - Phone:641-420-3764
Mailing Address - Fax:
Practice Address - Street 1:1384 109TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-4543
Practice Address - Country:US
Practice Address - Phone:763-757-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MND140401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program