Provider Demographics
NPI:1659515328
Name:CROWDER, VIRGINIA B (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:B
Last Name:CROWDER
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:MISS
Other - First Name:VIRGINA
Other - Middle Name:RUTH
Other - Last Name:BOYLSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1604 PHYSICIANS DR STE 103
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7349
Mailing Address - Country:US
Mailing Address - Phone:910-762-1234
Mailing Address - Fax:910-762-1232
Practice Address - Street 1:1604 PHYSICIANS DR STE 103
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7349
Practice Address - Country:US
Practice Address - Phone:910-762-1234
Practice Address - Fax:910-762-1232
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC158977163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant