Basic Information
| Provider Information | |||||||||
| NPI: | 1881129427 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROWFOOT LAPHAM | ||||||||
| FirstName: | CAPELLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3896 BEVERLY AVE NE STE 40 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973051374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035880076 | ||||||||
| FaxNumber: | 5035887578 | ||||||||
| Practice Location | |||||||||
| Address1: | 3896 BEVERLY AVE NE STE 40 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973051374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035880076 | ||||||||
| FaxNumber: | 5035887578 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2017 | ||||||||
| LastUpdateDate: | 03/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 201507166RN | OR | N | Nursing Service Providers | Registered Nurse | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 363L00000X | 201707556NP-PP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.