Provider Demographics
NPI:1689122087
Name:CROWLEY, LOREN (CRNA)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LOREN
Other - Middle Name:
Other - Last Name:WIGNALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:107 CLEVELAND AVE
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3810
Mailing Address - Country:US
Mailing Address - Phone:516-729-9322
Mailing Address - Fax:
Practice Address - Street 1:107 CLEVELAND AVE
Practice Address - Street 2:APARTMENT 1
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3810
Practice Address - Country:US
Practice Address - Phone:516-729-9322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY645830367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered