Provider Demographics
NPI:1093096620
Name:CROUCH, COLLEEN M (CRNA)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:CROUCH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 MIDLOTHIAN TPKE
Mailing Address - Street 2:SUITE 265
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4724
Mailing Address - Country:US
Mailing Address - Phone:804-594-2622
Mailing Address - Fax:804-594-0915
Practice Address - Street 1:8700 STONY POINT PKWY STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1968
Practice Address - Country:US
Practice Address - Phone:804-775-4500
Practice Address - Fax:804-545-0758
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169796367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ38029AOtherMEDICARE PTAN