Healthcare Provider Details

I. General information

NPI: 1467580555
Provider Name (Legal Business Name): CATHLEEN MARIE CROWLEY-KOSCHNITZKI CNM, FNP, DNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 11/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 COMMONS WAY
GREENVILLE SC
29611-3850
US

IV. Provider business mailing address

117 COMMONS WAY
GREENVILLE SC
29611-3850
US

V. Phone/Fax

Practice location:
  • Phone: 864-520-2020
  • Fax: 864-640-4400
Mailing address:
  • Phone: 864-520-2020
  • Fax: 864-440-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3378
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3378
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number3378
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3378
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: