MEDICARE: SAVANNA KAY CROSBY LPN

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	164W00000X	Licensed Practical Nurse	0002100964	VA

General Provider Information

NPI Number	:	1487227757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNA KAY CROSBY LPN

Provider Business Mailing Address
First Line	:	9111 BLOUNTS CORNER RD
Second Line	:
City	:	SMITHFIELD
State	:	VA
Zip	:	23430-2853
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 WILLIAMSBURG LANDING DR
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-8064
Country	:	US
Telephone Number	:	757-565-6505
Fax Number	:

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

Provider Enumeration Date	:	07/23/2021
Last Update Date	:	07/23/2021

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