Healthcare Provider Details

I. General information

NPI: 1912598384
Provider Name (Legal Business Name): AUSTIN BLAKE CROWDER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 VICTORIA ST # VB360A
PITTSBURGH PA
15213-2543
US

IV. Provider business mailing address

127 GLENDA DR
BONAIRE GA
31005-3565
US

V. Phone/Fax

Practice location:
  • Phone: 888-747-0794
  • Fax:
Mailing address:
  • Phone: 478-972-6249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN280108
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberTLRN061816
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024189409
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: