Provider Demographics
NPI:1689290868
Name:CRANE, ALICIA LYNN
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:LYNN
Last Name:CRANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:LYNN
Other - Last Name:CRANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:230 CARBON AVE
Mailing Address - Street 2:
Mailing Address - City:ROBERTS
Mailing Address - State:MT
Mailing Address - Zip Code:59070-9421
Mailing Address - Country:US
Mailing Address - Phone:208-946-0988
Mailing Address - Fax:
Practice Address - Street 1:230 CARBON AVE
Practice Address - Street 2:
Practice Address - City:ROBERTS
Practice Address - State:MT
Practice Address - Zip Code:59070-9421
Practice Address - Country:US
Practice Address - Phone:208-946-0988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-240076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily