Provider Demographics
NPI:1568109494
Name:CROWE, AUDREE ANA (NP)
Entity Type:Individual
Prefix:
First Name:AUDREE
Middle Name:ANA
Last Name:CROWE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AUDREE
Other - Middle Name:ANA
Other - Last Name:CROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10818
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-0818
Mailing Address - Country:US
Mailing Address - Phone:909-382-0201
Mailing Address - Fax:909-495-1330
Practice Address - Street 1:165 N CLARK ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2108
Practice Address - Country:US
Practice Address - Phone:559-233-8657
Practice Address - Fax:909-494-7644
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020823363L00000X, 363LF0000X
UT9900952-3102163W00000X
CA95185488163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily