Provider Demographics
NPI:1508916339
Name:CRUMP, TIM L (MSN, FNP)
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:L
Last Name:CRUMP
Suffix:
Gender:M
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 NE EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3253
Mailing Address - Country:US
Mailing Address - Phone:503-235-0140
Mailing Address - Fax:
Practice Address - Street 1:UP UNIVERSITY HEALTH CENTER
Practice Address - Street 2:5000 N WILLAMETTE BLVD
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-5798
Practice Address - Country:US
Practice Address - Phone:503-943-7134
Practice Address - Fax:503-943-7199
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR088006487N1 FNP-PP363LF0000X
OR163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR088006487N1 FNP-PPOtherSTATE NURSING LICENSE, NP
OR123914OtherOMAP NUMBER
ORMC0073659OtherDEA NUMBER
OR123914OtherOMAP NUMBER