Healthcare Provider Details

I. General information

NPI: 1649981564
Provider Name (Legal Business Name): PORTIA CROWDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7428 MANOR CREEK LOOP
NEW ALBANY OH
43054-8349
US

IV. Provider business mailing address

7428 MANOR CREEK LOOP
NEW ALBANY OH
43054-8349
US

V. Phone/Fax

Practice location:
  • Phone: 614-402-6152
  • Fax:
Mailing address:
  • Phone: 614-402-6152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number437005
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number437005
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number437005
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number437005
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number437005
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: