Healthcare Provider Details

I. General information

NPI: 1003174905
Provider Name (Legal Business Name): CAITLIN LEE CROWELL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 KOLBE RD STE 205
LORAIN OH
44053-1677
US

IV. Provider business mailing address

PO BOX 636643
CINCINNATI OH
45264-6646
US

V. Phone/Fax

Practice location:
  • Phone: 440-989-1800
  • Fax: 440-989-1801
Mailing address:
  • Phone: 440-989-3801
  • Fax: 440-960-0264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.003339
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: