Provider Demographics
NPI:1831539576
Name:CROWDER, KATHLEEN N (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:N
Last Name:CROWDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:NEWSOME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1074 WATKINS GLEN CT
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-8364
Mailing Address - Country:US
Mailing Address - Phone:937-645-0124
Mailing Address - Fax:
Practice Address - Street 1:1074 WATKINS GLEN CT
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-8364
Practice Address - Country:US
Practice Address - Phone:937-645-0124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN182072163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse