Provider Demographics
NPI:1710547187
Name:CRESSWELL, GREGORY ALAN (CRNA)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:CRESSWELL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 YANKEE DR
Mailing Address - Street 2:
Mailing Address - City:KEEDYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21756-1329
Mailing Address - Country:US
Mailing Address - Phone:301-639-8682
Mailing Address - Fax:
Practice Address - Street 1:2500 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3402
Practice Address - Country:US
Practice Address - Phone:304-264-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR183128367500000X
WV103755367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered