Provider Demographics
NPI:1104098581
Name:CROWDER, ELIZABETH ADAMS
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ADAMS
Last Name:CROWDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SUMMIT DRIVE
Mailing Address - Street 2:12D
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609
Mailing Address - Country:US
Mailing Address - Phone:864-298-0053
Mailing Address - Fax:
Practice Address - Street 1:400 SUMMIT DRIVE
Practice Address - Street 2:12D
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609
Practice Address - Country:US
Practice Address - Phone:864-298-0053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC112788R374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide