Provider Demographics
NPI:1548762826
Name:CROMWELL, KRISSY LAVONNE (RN)
Entity Type:Individual
Prefix:
First Name:KRISSY
Middle Name:LAVONNE
Last Name:CROMWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 MAHONE AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23523-1445
Mailing Address - Country:US
Mailing Address - Phone:757-724-7800
Mailing Address - Fax:
Practice Address - Street 1:1032 MAHONE AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23523-1445
Practice Address - Country:US
Practice Address - Phone:757-724-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001241460163W00000X
VA320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No163W00000XNursing Service ProvidersRegistered Nurse