Provider Demographics
NPI:1356521025
Name:CROWLEY, NINA MARIE (RD)
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:MARIE
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:169 ASHLEY AVE
Mailing Address - Street 2:SUITE EH110B, PO BOX 250905
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8905
Mailing Address - Country:US
Mailing Address - Phone:843-792-4100
Mailing Address - Fax:843-792-8364
Practice Address - Street 1:169 ASHLEY AVE
Practice Address - Street 2:SUITE EH110B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8905
Practice Address - Country:US
Practice Address - Phone:843-792-4100
Practice Address - Fax:843-792-8364
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered