Healthcare Provider Details

I. General information

NPI: 1114909033
Provider Name (Legal Business Name): LLEW ALAN CROWDER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 02/16/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 STANAFORD RD
BECKLEY WV
25801-3142
US

IV. Provider business mailing address

3100 SPRING FOREST RD STE 130
RALEIGH NC
27616-2880
US

V. Phone/Fax

Practice location:
  • Phone: 304-255-3000
  • Fax:
Mailing address:
  • Phone: 919-882-0705
  • Fax: 919-873-9821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number48782
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024172319
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: