Healthcare Provider Details

I. General information

NPI: 1699837005
Provider Name (Legal Business Name): ROSLYN JILL CREWS PEDIATRIC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 WORLEY DR
ALEXANDRIA LA
71301
US

IV. Provider business mailing address

PO BOX 5404
ALEXANDRIA LA
71307
US

V. Phone/Fax

Practice location:
  • Phone: 318-443-9634
  • Fax: 318-443-9809
Mailing address:
  • Phone: 318-443-9634
  • Fax: 318-443-9809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: