Basic Information
Provider Information | |||||||||
NPI: | 1447578711 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CRANE | ||||||||
FirstName: | DESIREE | ||||||||
MiddleName: | HANSEN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HANSEN | ||||||||
OtherFirstName: | DESIREE | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 30180 | ||||||||
Address2: |   | ||||||||
City: | SALT LAKE CITY | ||||||||
State: | UT | ||||||||
PostalCode: | 841300180 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2088602441 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 5121 S COTTONWOOD ST | ||||||||
Address2: |   | ||||||||
City: | MURRAY | ||||||||
State: | UT | ||||||||
PostalCode: | 841075701 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8015076600 | ||||||||
FaxNumber: | 8014420643 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/12/2010 | ||||||||
LastUpdateDate: | 01/28/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/28/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 20A12715 | CA | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207P00000X | 34.010668 | OH | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207P00000X | 9601876-1204 | UT | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
No ID Information.