Individual
MS. CAROL L CROCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
500 MAIN ST STE A, SPRINGFIELD, OR 97477-5484
(541) 505-0027
Mailing address
184 GREENVALE DR, SPRINGFIELD, OR 97477-2112
(541) 736-3406
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200450098NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
027960
—
OR
Enumeration date
07/16/2007
Last updated
07/17/2020
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