Healthcare Provider Details

I. General information

NPI: 1063005262
Provider Name (Legal Business Name): CARINNE CROUSE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N MAIN ST STE 120
SPRINGBORO OH
45066-2100
US

IV. Provider business mailing address

1 PRESTIGE PL STE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-762-1306
  • Fax: 937-762-5039
Mailing address:
  • Phone: 937-762-1306
  • Fax: 937-522-7017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP0028237
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: