Provider Demographics
NPI:1841437597
Name:BECTON CROUSE, MARY LAUREEN (FNP-BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LAUREEN
Last Name:BECTON CROUSE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15696 US HIGHWAY 380 W
Mailing Address - Street 2:PO BOX 657
Mailing Address - City:KRUM
Mailing Address - State:TX
Mailing Address - Zip Code:76249-6696
Mailing Address - Country:US
Mailing Address - Phone:940-294-2944
Mailing Address - Fax:
Practice Address - Street 1:2501 W OAK ST STE 101
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4324
Practice Address - Country:US
Practice Address - Phone:940-294-2944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-17
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX612543363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily