Provider Demographics
NPI:1326490244
Name:CROWTHER, LISA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:CROWTHER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 HOWARD AVE
Mailing Address - Street 2:DANA BUILDING 3RD FLOOR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1369
Mailing Address - Country:US
Mailing Address - Phone:203-785-7191
Mailing Address - Fax:203-785-2917
Practice Address - Street 1:800 HOWARD AVE
Practice Address - Street 2:YALE PHYSICIAN BUILDING 2ND FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1369
Practice Address - Country:US
Practice Address - Phone:203-785-7191
Practice Address - Fax:203-785-2917
Is Sole Proprietor?:No
Enumeration Date:2016-07-02
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT068972163W00000X
CT6603363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse