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General NPI Number Information
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NPI Number | 1801370903
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Entity Type | Individual
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Provider Name | VICKI LYNN CROUSE AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/24/2018
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 55 WHITCHER ST NE STE 160
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City | MARIETTA
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State | GA
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Zip | 30060-1160
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Country | US
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Telephone | 470-956-8276
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Fax |
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Provider Business Mailing Address
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Address Line | 417 SETTLERS RIDGE LN
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City | HIRAM
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State | GA
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Zip | 30141-3424
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Country | US
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Telephone | 678-622-7497
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | RN209524
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License Number State | GA
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