Provider Demographics
NPI:1114202207
Name:CROWE, LORA ELIZABETH (MSN, APRN-BC)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:ELIZABETH
Last Name:CROWE
Suffix:
Gender:F
Credentials:MSN, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 DAVINCI CT
Mailing Address - Street 2:STE 400
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-7627
Mailing Address - Country:US
Mailing Address - Phone:478-781-6575
Mailing Address - Fax:
Practice Address - Street 1:3720 DAVINCI CT
Practice Address - Street 2:STE 400
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-7627
Practice Address - Country:US
Practice Address - Phone:478-781-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN153999363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAS63351Medicare UPIN