Provider Demographics
NPI:1932170628
Name:CROMWELL, GALE GENEVIEVE (CRNP)
Entity Type:Individual
Prefix:
First Name:GALE
Middle Name:GENEVIEVE
Last Name:CROMWELL
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 1:205 RIDGELY AVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1303
Mailing Address - Country:US
Mailing Address - Phone:410-263-6910
Mailing Address - Fax:443-433-0470
Practice Address - Street 1:205 RIDGELY AVE
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-263-6910
Practice Address - Fax:443-433-0470
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR076293363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD78536110Medicaid
MDR076293OtherSTATE LICENSE
S71739Medicare UPIN