Provider Demographics
NPI:1932305943
Name:CRANE, ERICA SECRIST (CNIM)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:SECRIST
Last Name:CRANE
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:SECRIST
Other - Last Name:CRANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNIM
Mailing Address - Street 1:PO BOX 705
Mailing Address - Street 2:
Mailing Address - City:INDIAN HILLS
Mailing Address - State:CO
Mailing Address - Zip Code:80454-0705
Mailing Address - Country:US
Mailing Address - Phone:541-517-1206
Mailing Address - Fax:
Practice Address - Street 1:10103 RIDGEGATE PKWY
Practice Address - Street 2:SUITE 306
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5520
Practice Address - Country:US
Practice Address - Phone:303-225-8120
Practice Address - Fax:303-225-8130
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1181246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other