MEDICARE: LORI MAE CROUSE RN

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	163W00000X	Registered Nurse	9587918	FL

General Provider Information

NPI Number	:	1992684849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI MAE CROUSE RN

Provider Business Mailing Address
First Line	:	2776 CLEVELAND AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-5864
Country	:	US
Telephone Number	:	239-343-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2728 SW 18TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-4022
Country	:	US
Telephone Number	:	239-898-2557
Fax Number	:

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

Provider Enumeration Date	:	08/27/2025
Last Update Date	:	08/27/2025

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