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General NPI Number Information
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NPI Number | 1164900049
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Entity Type | Individual
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Provider Name | DANIELLE KANAVY CROUSE NP
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Gender | Female
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Dates
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Enumeration Date | 08/01/2018
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 9600 PULASKI PARK DR STE 103
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City | BALTIMORE
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State | MD
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Zip | 21220-1472
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Country | US
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Telephone | 443-725-8245
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Fax | 443-725-8217
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Provider Business Mailing Address
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Address Line | 200 CORPORATE BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70508-3870
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Country | US
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Telephone | 800-893-9698
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0001142337
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN.CNP.023594
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License Number State | OH
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