Provider Demographics
NPI:1003174905
Name:CROWELL, CAITLIN LEE (PA)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:LEE
Last Name:CROWELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636643
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-6646
Mailing Address - Country:US
Mailing Address - Phone:440-989-3801
Mailing Address - Fax:440-960-0264
Practice Address - Street 1:3600 KOLBE RD STE 205
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1677
Practice Address - Country:US
Practice Address - Phone:440-989-1800
Practice Address - Fax:440-989-1801
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003339363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3025372Medicaid
OH9389631Medicare PIN