Provider Demographics
NPI:1942491980
Name:CREWS, DOROTHEA
Entity Type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:
Last Name:CREWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEE
Other - Middle Name:
Other - Last Name:CREWS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:713 NW SPRUCE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-9535
Mailing Address - Country:US
Mailing Address - Phone:772-692-2083
Mailing Address - Fax:
Practice Address - Street 1:713 NW SPRUCE RIDGE DR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-9535
Practice Address - Country:US
Practice Address - Phone:772-692-2083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0678661164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse