Provider Demographics
NPI:1104006386
Name:CROASTON, DANETTE LYNNE (CRNA)
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:LYNNE
Last Name:CROASTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DANETTE
Other - Middle Name:LYNNE
Other - Last Name:CABE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:111 LONE PINE DR
Mailing Address - Street 2:
Mailing Address - City:MASONTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26542-8605
Mailing Address - Country:US
Mailing Address - Phone:304-376-6557
Mailing Address - Fax:
Practice Address - Street 1:111 LONE PINE DR
Practice Address - Street 2:
Practice Address - City:MASONTOWN
Practice Address - State:WV
Practice Address - Zip Code:26542-8605
Practice Address - Country:US
Practice Address - Phone:304-376-6557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV61484367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010505Medicaid
OH2830735Medicaid
OH2830735Medicaid
WV27005299701OtherWORKERS COMP
WVDA0096OtherRAILROAD MEDICARE
WV270052997OtherTRICARE
OH$$$$$$$$$00OtherOHIO WORKERS COMP
WV002000215OtherMSBCBS
WV3810010505Medicaid
WV8241131Medicare PIN
WV1072423OtherWORKERS COM INDIVIDUAL
OH2830735Medicaid
WVP00477311OtherRAILROAD MEDICARE