Provider Demographics
NPI:1942423132
Name:CROUCH, ELLEN CONROY (RN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:CONROY
Last Name:CROUCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 FAIRBANKS ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2503
Mailing Address - Country:US
Mailing Address - Phone:508-789-1396
Mailing Address - Fax:
Practice Address - Street 1:11 WINFIELD ST
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-4125
Practice Address - Country:US
Practice Address - Phone:617-268-6084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232708163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics