Provider Demographics
NPI:1669576781
Name:CROTHERS, ANGELA MARIE (NP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:CROTHERS
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 1:28465 SUTHERLIN LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-9400
Mailing Address - Country:US
Mailing Address - Phone:541-213-3278
Mailing Address - Fax:
Practice Address - Street 1:1030 WILLAGILLESPIE RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2123
Practice Address - Country:US
Practice Address - Phone:541-653-9158
Practice Address - Fax:541-653-8694
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21657363LW0102X, 363LW0102X
OR201805148NP-PP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB242745OtherMEDICARE ID