Provider Demographics
NPI:1275395501
Name:CROWL, KATHLEEN M (LPN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:CROWL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:CROWL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:17 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:NY
Mailing Address - Zip Code:13142-4406
Mailing Address - Country:US
Mailing Address - Phone:315-901-2528
Mailing Address - Fax:
Practice Address - Street 1:17 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:NY
Practice Address - Zip Code:13142-4406
Practice Address - Country:US
Practice Address - Phone:315-901-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334483164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse