Provider Demographics
NPI:1336444892
Name:CRUMRINE, DIANA R (ND)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:R
Last Name:CRUMRINE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1504 S LONGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-3732
Mailing Address - Country:US
Mailing Address - Phone:208-407-7455
Mailing Address - Fax:208-906-1489
Practice Address - Street 1:1416 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5038
Practice Address - Country:US
Practice Address - Phone:208-906-1485
Practice Address - Fax:208-906-1489
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60187396175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath