Healthcare Provider Details

I. General information

NPI: 1689122087
Provider Name (Legal Business Name): LOREN CROWLEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LOREN WIGNALL CRNA

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 08/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CLEVELAND AVE APARTMENT 1
LONG BEACH NY
11561-3810
US

IV. Provider business mailing address

107 CLEVELAND AVE APARTMENT 1
LONG BEACH NY
11561-3810
US

V. Phone/Fax

Practice location:
  • Phone: 516-729-9322
  • Fax:
Mailing address:
  • Phone: 516-729-9322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number645830
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: