Provider Demographics
NPI:1093496549
Name:CROOKENDALE, DEBRA ROSEMARY (MSN RN)
Entity Type:Individual
Prefix:MISS
First Name:DEBRA
Middle Name:ROSEMARY
Last Name:CROOKENDALE
Suffix:
Gender:F
Credentials:MSN RN
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Mailing Address - Street 1:3472 BERTHA DR
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-5052
Mailing Address - Country:US
Mailing Address - Phone:845-777-5835
Mailing Address - Fax:
Practice Address - Street 1:3472 BERTHA DR
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-5052
Practice Address - Country:US
Practice Address - Phone:845-777-5835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY568460163WP0000X, 163WP0809X, 163WA2000X, 163WC0200X, 163WC2100X, 163WC3500X, 163WD0400X, 163WD1100X, 163WE0900X, 163WG0600X, 163WH0200X, 163WI0500X, 163WM0705X, 163WU0100X, 163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WD1100XNursing Service ProvidersRegistered NurseDialysis, Peritoneal
No163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WU0100XNursing Service ProvidersRegistered NurseUrology