Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 32141 | CA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 202002222 | OR |
NPI | 1871862565 |
---|---|
Provider Name | Jason Crowley |
First Address | South Lake Tahoe, CA 96150-7807 |
Second Address | South Lake Tahoe, CA 96150-7807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2011 |
Last Update Date | 18/03/2020 |