Provider Demographics
NPI:1699389262
Name:CROW, BLYTHE
Entity Type:Individual
Prefix:
First Name:BLYTHE
Middle Name:
Last Name:CROW
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:PO BOX 2837
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-2837
Mailing Address - Country:US
Mailing Address - Phone:970-986-8588
Mailing Address - Fax:
Practice Address - Street 1:551 GRAND AVE STE 304
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2694
Practice Address - Country:US
Practice Address - Phone:970-986-8588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2023-05-25
Deactivation Date:2023-02-10
Deactivation Code:
Reactivation Date:2023-05-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program