MEDICARE: DR. CATHLEEN MARIE CROWLEY-KOSCHNITZKI CNM, FNP, DNP, PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	3378	SC
2	363LF0000X	Family Nurse Practitioner	3378	SC
3	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	3378	SC
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	3378	SC

General Provider Information

NPI Number	:	1467580555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHLEEN MARIE CROWLEY-KOSCHNITZKI CNM, FNP, DNP, PMHNP

Provider Business Mailing Address
First Line	:	117 COMMONS WAY
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-3850
Country	:	US
Telephone Number	:	864-520-2020
Fax Number	:	864-440-4400

Provider Business Practice Location Address
First Line	:	117 COMMONS WAY
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-3850
Country	:	US
Telephone Number	:	864-520-2020
Fax Number	:	864-640-4400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	11/17/2019

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