Healthcare Provider Details

I. General information

NPI: 1720256712
Provider Name (Legal Business Name): LORA BROWN CROWELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BERKELEY COUNTY BOARD OF EDUCATION 401 SOUTH QUEEN STREET
MARTINSBURG WV
25401
US

IV. Provider business mailing address

334 SCHOOL HOUSE DR
HEDGESVILLE WV
25427-7220
US

V. Phone/Fax

Practice location:
  • Phone: 304-267-3500
  • Fax: 304-267-3524
Mailing address:
  • Phone: 304-754-3313
  • Fax: 304-754-6613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28083
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: