Provider Demographics
NPI:1174371074
Name:CRAMBLETTE, CASPER LEON
Entity type:Individual
Prefix:MR
First Name:CASPER
Middle Name:LEON
Last Name:CRAMBLETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CASSIDEE
Other - Middle Name:MARIE
Other - Last Name:CRAMBLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:319 7TH AVE SE STE 201
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:319 7TH AVE SE STE 201
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1325
Practice Address - Country:US
Practice Address - Phone:360-529-7287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist