Healthcare Provider Details

I. General information

NPI: 1922078054
Provider Name (Legal Business Name): MARYANNE - CROWTHER NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 ROUTE 33 JSUMC, ACKERMAN 369
NEPTUNE NJ
07753-4859
US

IV. Provider business mailing address

1103 JEFFREY AVE
OCEAN NJ
07712-4134
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-4196
  • Fax: 732-776-2488
Mailing address:
  • Phone: 732-776-4196
  • Fax: 732-776-4196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NN07132500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number26NC07132500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: