MEDICARE: JOHN R CROUCH CRNP

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	363LF0000X	Family Nurse Practitioner	1-097401	AL

General Provider Information

NPI Number	:	1407897036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN R CROUCH CRNP

Provider Business Mailing Address
First Line	:	PO BOX 298
Second Line	:
City	:	FLORENCE
State	:	AL
Zip	:	35631-0298
Country	:	US
Telephone Number	:	256-767-7494
Fax Number	:	256-760-8432

Provider Business Practice Location Address
First Line	:	204 LOWE AVE SE
Second Line	:	SUITE 4
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-4262
Country	:	US
Telephone Number	:	256-533-3020
Fax Number	:	256-533-3122

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/08/2007

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Directions to “ JOHN R CROUCH CRNP” Practice Location

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