Basic Information
| Provider Information | |||||||||
| NPI: | 1154368538 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROWELL | ||||||||
| FirstName: | NANNETTE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 LITTLE MOUNTAIN LN | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982748752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604166735 | ||||||||
| FaxNumber: | 3604246954 | ||||||||
| Practice Location | |||||||||
| Address1: | 2131 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SEDRO WOOLLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982844301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604166735 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | MD00022248 | WA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 1008481 | 05 | WA | MEDICAID | 180003709 | 01 | RAILROAD MEDICARE | OTHER |