Provider Demographics
NPI:1982183174
Name:CROUCH, DORIS H (RN BSN)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:H
Last Name:CROUCH
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 HUNTS POINTE DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-1934
Mailing Address - Country:US
Mailing Address - Phone:175-741-6448
Mailing Address - Fax:
Practice Address - Street 1:5660 INDIAN RIVER RD STE 100
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5240
Practice Address - Country:US
Practice Address - Phone:757-366-5423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001172224163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse