Provider Demographics
NPI:1851532220
Name:CRANE, KARA LYNN (NP)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:LYNN
Last Name:CRANE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42600 MIRAGE RD
Mailing Address - Street 2:BLDG A1
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4127
Mailing Address - Country:US
Mailing Address - Phone:760-416-6971
Mailing Address - Fax:
Practice Address - Street 1:42600 MIRAGE RD
Practice Address - Street 2:BLDG A1
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4127
Practice Address - Country:US
Practice Address - Phone:760-416-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA569628363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ58523Medicare UPIN