Provider Demographics
NPI:1215331632
Name:CROUSE, EMILY ANNE DOUGHTY (APRN)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE DOUGHTY
Last Name:CROUSE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANNE
Other - Last Name:DOUGHTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:ONE MEDICAL CENTER DRIVE
Mailing Address - Street 2:PAIN MANAGEMENT
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-0001
Mailing Address - Country:US
Mailing Address - Phone:603-650-6040
Mailing Address - Fax:
Practice Address - Street 1:ONE MEDICAL CENTER DRIVE
Practice Address - Street 2:PAIN MANAGEMENT
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-0001
Practice Address - Country:US
Practice Address - Phone:603-650-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338973-1363LF0000X
NH078516-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1033318Medicaid
NH3113381Medicaid
NYF338973-1OtherOFFICE OF THE PROFESSIONS