Provider Demographics
NPI:1255013868
Name:CRUTCHLOW, JOHN EDWARD JR (RN)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:CRUTCHLOW
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 W WARNER RD
Mailing Address - Street 2:#101 PMB 111
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233
Mailing Address - Country:US
Mailing Address - Phone:520-664-6164
Mailing Address - Fax:
Practice Address - Street 1:9615 E COUNTY LINE RD STE B-665
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3527
Practice Address - Country:US
Practice Address - Phone:520-664-6164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC285908163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency