Provider Demographics
NPI:1740584572
Name:CROCKER, RICHARD E (CRNA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:CROCKER
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:CMR 402 BOX 2114
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180-0022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DR HITZELBERGER STRASSE
Practice Address - Street 2:
Practice Address - City:LANDSTUHL
Practice Address - State:GERMANY
Practice Address - Zip Code:66849
Practice Address - Country:DE
Practice Address - Phone:499-464-5762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001235903163W00000X
VA0024169892367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse