Provider Demographics
NPI:1801512173
Name:CRAWSHAW, NATHAN ALEC (PA-C)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:ALEC
Last Name:CRAWSHAW
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 GW LN
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-2339
Mailing Address - Country:US
Mailing Address - Phone:573-774-2715
Mailing Address - Fax:573-202-2410
Practice Address - Street 1:1000 GW LN
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-2339
Practice Address - Country:US
Practice Address - Phone:573-855-7593
Practice Address - Fax:573-774-2792
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022040648363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant