Healthcare Provider Details

I. General information

NPI: 1043754518
Provider Name (Legal Business Name): MARC CHASEN CROSHAW PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2016
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N SPRING ST
CALIENTE NV
89008-1010
US

IV. Provider business mailing address

PO BOX 1010
CALIENTE NV
89008-1010
US

V. Phone/Fax

Practice location:
  • Phone: 775-726-3121
  • Fax: 775-726-3666
Mailing address:
  • Phone: 775-726-3171
  • Fax: 775-726-3797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: