Provider Demographics
NPI:1801977988
Name:CROUSE, DEDRA DENISE (FNP)
Entity type:Individual
Prefix:
First Name:DEDRA
Middle Name:DENISE
Last Name:CROUSE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DEDRA
Other - Middle Name:DENISE
Other - Last Name:DEEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2347
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266
Mailing Address - Country:US
Mailing Address - Phone:276-889-7621
Mailing Address - Fax:
Practice Address - Street 1:75 ROGERS STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266
Practice Address - Country:US
Practice Address - Phone:276-889-7621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily