Provider Demographics
NPI:1689648974
Name:CROSSON, LENORE S (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LENORE
Middle Name:S
Last Name:CROSSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 ELM STREET
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082
Mailing Address - Country:US
Mailing Address - Phone:860-741-2225
Mailing Address - Fax:860-651-1404
Practice Address - Street 1:714 HOPMEADOW STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070
Practice Address - Country:US
Practice Address - Phone:860-741-2225
Practice Address - Fax:860-651-1404
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002480363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT363L00000XMedicaid
CT400002480CT03OtherBLUE SHIELD #
CTOXFORDOtherP3605030
CT500001398Medicare ID - Type UnspecifiedMEDICARE #
CT363L00000XMedicaid