Provider Demographics
NPI:1962841213
Name:CROCKER, EMILY D (RN)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:D
Last Name:CROCKER
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 1:1300 E BLACKSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:SC
Mailing Address - Zip Code:29369-9656
Mailing Address - Country:US
Mailing Address - Phone:864-576-8088
Mailing Address - Fax:864-595-2418
Practice Address - Street 1:1300 E BLACKSTOCK RD
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:SC
Practice Address - Zip Code:29369-9656
Practice Address - Country:US
Practice Address - Phone:864-576-8088
Practice Address - Fax:864-595-2418
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC62533163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse