Provider Demographics
NPI:1336512250
Name:CROWDER, WONZA DENISE (LPN)
Entity Type:Individual
Prefix:
First Name:WONZA
Middle Name:DENISE
Last Name:CROWDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 YOUNGS MILL RD
Mailing Address - Street 2:G
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-1387
Mailing Address - Country:US
Mailing Address - Phone:706-616-8270
Mailing Address - Fax:
Practice Address - Street 1:372 YOUNGS MILL RD
Practice Address - Street 2:G
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-1387
Practice Address - Country:US
Practice Address - Phone:706-616-8270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN077339164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse