Provider Demographics
NPI:1710530720
Name:CROWLEY, AVERIL ALICEN (FNP-C)
Entity Type:Individual
Prefix:
First Name:AVERIL
Middle Name:ALICEN
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 43RD ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-3712
Mailing Address - Country:US
Mailing Address - Phone:616-455-4114
Mailing Address - Fax:616-455-4454
Practice Address - Street 1:2120 43RD ST SE STE 200
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-3712
Practice Address - Country:US
Practice Address - Phone:616-455-4114
Practice Address - Fax:616-455-4454
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704271778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily