Provider Demographics
NPI:1750383089
Name:CROWTHER, CHRISTY L (CRNP)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:L
Last Name:CROWTHER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 MEDICAL PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7992
Mailing Address - Country:US
Mailing Address - Phone:410-573-2530
Mailing Address - Fax:
Practice Address - Street 1:2003 MEDICAL PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7992
Practice Address - Country:US
Practice Address - Phone:410-573-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR062698363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR12646Medicare UPIN