Provider Demographics
NPI:1851364319
Name:CROCKER-WENSEL, KAREN E (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:E
Last Name:CROCKER-WENSEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 WILLAMETTE ST STE 330
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-344-5363
Mailing Address - Fax:541-344-5369
Practice Address - Street 1:859 WILLAMETTE ST STE 330
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-344-5363
Practice Address - Fax:541-344-5369
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD217822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181441Medicaid
OR181441Medicaid
ORRR PTAN 260040463Medicare PIN
F62847Medicare UPIN