Provider Demographics
NPI:1972654374
Name:CRENSHAW, GWENDOLYN EMMA DUSO (APN, FNP)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:EMMA DUSO
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:APN, FNP
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 94670
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73143-4670
Mailing Address - Country:US
Mailing Address - Phone:405-682-3303
Mailing Address - Fax:405-384-6793
Practice Address - Street 1:9352 PARK WEST BLVD
Practice Address - Street 2:ATTN: PARKWEST SLEEP DISORDERS CENTER
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923
Practice Address - Country:US
Practice Address - Phone:865-373-1975
Practice Address - Fax:865-373-1059
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341414Medicaid
TN3341414OtherMEDICARE-PTAN
TN3341415OtherMEDICARE-PTAN