Healthcare Provider Details

I. General information

NPI: 1801933213
Provider Name (Legal Business Name): RITA CROWLEY PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MAIN STREET SUITE 200
OGDENSBURG NY
13669
US

IV. Provider business mailing address

305 MAIN STREET SUITE 200
OGDENSBURG NY
13669
US

V. Phone/Fax

Practice location:
  • Phone: 315-713-6770
  • Fax: 877-902-6131
Mailing address:
  • Phone: 315-713-6770
  • Fax: 877-902-6131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF380414
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: