Provider Demographics
NPI:1346649993
Name:CROWTHERS, STEVEN SCOTT (CRNA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:SCOTT
Last Name:CROWTHERS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 LAUREL ST # 445
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-9454
Mailing Address - Country:US
Mailing Address - Phone:970-946-2918
Mailing Address - Fax:
Practice Address - Street 1:745 LAUREL ST # 445
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530-9454
Practice Address - Country:US
Practice Address - Phone:970-946-2918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO189597163WC0200X
CANA95000228367500000X
OR201502217367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM379446YKNVMedicaid