Provider Demographics
NPI:1750460069
Name:CROWELL, CYNTHIA LU (CRNA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LU
Last Name:CROWELL
Suffix:
Gender:F
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:PO BOX 701943
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75370-1943
Mailing Address - Country:US
Mailing Address - Phone:214-454-9373
Mailing Address - Fax:972-818-1443
Practice Address - Street 1:4210 BRETTON BAY CIR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-6705
Practice Address - Country:US
Practice Address - Phone:214-454-9373
Practice Address - Fax:972-818-1443
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX513637367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
039402OtherAANA/RECERTIFICATION