Provider Demographics
NPI:1952426892
Name:CROWDER, ANNIE (RNP)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:CROWDER
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:MISS
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5408 DUKE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-3904
Mailing Address - Country:US
Mailing Address - Phone:314-814-8670
Mailing Address - Fax:314-814-8542
Practice Address - Street 1:8630 FENTON ST STE 1204
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3808
Practice Address - Country:US
Practice Address - Phone:301-340-7525
Practice Address - Fax:301-495-0318
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC002288363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDN94208OtherCDS
MDAC002288OtherLICENSE