Provider Demographics
NPI:1154368538
Name:CROWELL, NANNETTE E (MD)
Entity type:Individual
Prefix:
First Name:NANNETTE
Middle Name:E
Last Name:CROWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 LITTLE MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-8752
Mailing Address - Country:US
Mailing Address - Phone:360-416-6735
Mailing Address - Fax:360-424-6954
Practice Address - Street 1:2131 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-4301
Practice Address - Country:US
Practice Address - Phone:360-416-6735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022248207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1008481Medicaid
180003709OtherRAILROAD MEDICARE
WAGA54856Medicare PIN
AB33585Medicare ID - Type Unspecified
WA1008481Medicaid