Provider Demographics
NPI:1881483543
Name:CROUCH, TIMOTHY L (RN)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:L
Last Name:CROUCH
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 PATRICK RD
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1542
Mailing Address - Country:US
Mailing Address - Phone:509-289-8108
Mailing Address - Fax:
Practice Address - Street 1:200 NAT WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1982
Practice Address - Country:US
Practice Address - Phone:509-754-4631
Practice Address - Fax:509-754-6569
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60265172163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency