Provider Demographics
NPI:1699012567
Name:CROUSE, BLAIR ROUTH (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:BLAIR
Middle Name:ROUTH
Last Name:CROUSE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:BLAIR
Other - Middle Name:
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:407 S MENDENHALL ST.
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403
Mailing Address - Country:US
Mailing Address - Phone:336-392-3641
Mailing Address - Fax:336-860-1649
Practice Address - Street 1:407 S MENDENHALL ST.
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403
Practice Address - Country:US
Practice Address - Phone:336-392-3641
Practice Address - Fax:336-860-1649
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006063363LA2200X, 363LG0600X, 363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care