Provider Demographics
NPI:1114627049
Name:CROCKETT, JAMANI LASHAWN
Entity type:Individual
Prefix:
First Name:JAMANI
Middle Name:LASHAWN
Last Name:CROCKETT
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:JAMANI
Other - Middle Name:
Other - Last Name:LASHAWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSS
Mailing Address - Street 1:1292 HIGH ST # 1227
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1292 HIGH ST # 1227
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3238
Practice Address - Country:US
Practice Address - Phone:313-283-4307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No175T00000XOther Service ProvidersPeer Specialist