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General NPI Number Information
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NPI Number | 1891030193
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Entity Type | Individual
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Provider Name | MICHELLE CROWE
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Gender | Female
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Dates
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Enumeration Date | 11/28/2012
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 2015 2ND AVE STE 101
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City | SUMMERVILLE
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State | SC
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Zip | 29486-7889
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Country | US
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Telephone | 843-737-9465
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Fax |
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Provider Business Mailing Address
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Address Line | 4975 LACROSS RD STE 150
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-6531
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Country | US
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Telephone | 843-737-9467
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA055761
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2333
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2333
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License Number State | SC
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