Healthcare Provider Details

I. General information

NPI: 1386626323
Provider Name (Legal Business Name): DONNIE A. CROLEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 09/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 NORTH MAIN
LOVINGTON NM
88260-2830
US

IV. Provider business mailing address

1600 NORTH MAIN
LOVINGTON NM
88260-2830
US

V. Phone/Fax

Practice location:
  • Phone: 575-396-6611
  • Fax: 575-396-1454
Mailing address:
  • Phone: 575-396-6611
  • Fax: 575-396-1454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR699683
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA-01338
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: