MEDICARE: KANINA DIANE CROSEN ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	1-105028	AL
2	363LA2200X	Adult Health Nurse Practitioner	RN208438	GA

General Provider Information

NPI Number	:	1346541273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANINA DIANE CROSEN ANP

Provider Business Mailing Address
First Line	:	96 ALI WAY
Second Line	:
City	:	OXFORD
State	:	AL
Zip	:	36203-1835
Country	:	US
Telephone Number	:	256-832-8802
Fax Number	:	256-832-8877

Provider Business Practice Location Address
First Line	:	96 ALI WAY
Second Line	:
City	:	OXFORD
State	:	AL
Zip	:	36203-1835
Country	:	US
Telephone Number	:	256-832-8802
Fax Number	:	256-832-8877

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2010
Last Update Date	:	05/30/2024

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Directions to “ KANINA DIANE CROSEN ANP” Practice Location

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