Healthcare Provider Details

I. General information

NPI: 1215919238
Provider Name (Legal Business Name): KATHIE DARWIN MCCROARY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANSTUHL REGIONAL MEDICAL CENTER ATTN: MCEUL-DCCS (CREDENTIALS), CMR 402
APO AE
09180
DE

IV. Provider business mailing address

CMR 427 BOX 3218
APO AE
09630
IT

V. Phone/Fax

Practice location:
  • Phone: 011390444717521
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: