Provider Demographics
NPI:1366050981
Name:CROWDER, NICOLE DAINESE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:DAINESE
Last Name:CROWDER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 763552
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75376-3552
Mailing Address - Country:US
Mailing Address - Phone:832-454-9453
Mailing Address - Fax:
Practice Address - Street 1:422 S CENTRE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-3829
Practice Address - Country:US
Practice Address - Phone:972-218-1671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1004345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily