Provider Demographics
NPI:1477396984
Name:CROUSE, NATASHA (LPN)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:CROUSE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:CROUSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:713 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-4128
Mailing Address - Country:US
Mailing Address - Phone:920-918-5958
Mailing Address - Fax:
Practice Address - Street 1:713 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-4128
Practice Address - Country:US
Practice Address - Phone:920-918-5958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI323347-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse