Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 4704323975 | MI |
NPI | 1023781705 |
---|---|
Provider Name | Courtney Anne Crowley |
First Address | Southfield, MI 48033-3849 |
Second Address | Troy, MI 48085-1117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2021 |
Last Update Date | 14/02/2022 |