Provider Demographics
NPI:1932552718
Name:CROUSE, NONA (NP)
Entity Type:Individual
Prefix:
First Name:NONA
Middle Name:
Last Name:CROUSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 BURTON HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651-8305
Mailing Address - Country:US
Mailing Address - Phone:276-970-4663
Mailing Address - Fax:
Practice Address - Street 1:1 CLINIC DR
Practice Address - Street 2:CLAYPOOL HILL
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-1102
Practice Address - Country:US
Practice Address - Phone:276-964-6771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily