Provider Demographics
NPI:1649981564
Name:CROWDER, PORTIA (RN)
Entity type:Individual
Prefix:MISS
First Name:PORTIA
Middle Name:
Last Name:CROWDER
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 1:7428 MANOR CREEK LOOP
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8349
Mailing Address - Country:US
Mailing Address - Phone:614-402-6152
Mailing Address - Fax:
Practice Address - Street 1:7428 MANOR CREEK LOOP
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8349
Practice Address - Country:US
Practice Address - Phone:614-402-6152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH437005163WI0500X, 163WW0000X, 163WX0200X, 163WX1500X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX0200XNursing Service ProvidersRegistered NurseOncology
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care