Basic Information
| Provider Information | |||||||||
| NPI: | 1619438249 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROW-PETERSEN | ||||||||
| FirstName: | JULIE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 45680 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941450680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306262618 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6065 STATE HIGHWAY 193 | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956349623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303332548 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2019 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | NP95011449 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.