Provider Demographics
NPI:1942291448
Name:CRUVANT, CAROLYN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:ANN
Last Name:CRUVANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:CAROLYN
Other - Middle Name:ANN
Other - Last Name:VENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 S STEPHANIE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5731
Mailing Address - Country:US
Mailing Address - Phone:702-202-4776
Mailing Address - Fax:702-202-6110
Practice Address - Street 1:3575 PECOS MCLEOD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3803
Practice Address - Country:US
Practice Address - Phone:702-731-2088
Practice Address - Fax:702-734-7836
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5853207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1942291448Medicaid
P00794417OtherRAILROAD MEDICARE PIN
NV002002632Medicaid
E34519Medicare UPIN