Provider Demographics
NPI:1912598384
Name:CROWDER, AUSTIN BLAKE (RN)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:BLAKE
Last Name:CROWDER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 GLENDA DR
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-3565
Mailing Address - Country:US
Mailing Address - Phone:478-972-6249
Mailing Address - Fax:
Practice Address - Street 1:3500 VICTORIA ST # VB360A
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2543
Practice Address - Country:US
Practice Address - Phone:888-747-0794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN280108163W00000X
PATLRN061816163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse