Basic Information
Provider Information
NPI: 1972084572
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CROWLEY
FirstName: BRIGITTE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1717 TIMBER LN
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891082420
CountryCode: US
TelephoneNumber: 7028123396
FaxNumber:  
Practice Location
Address1: 160 E HORIZON DR STE A
Address2:  
City: HENDERSON
State: NV
PostalCode: 890157934
CountryCode: US
TelephoneNumber: 7026443600
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/22/2018
LastUpdateDate: 08/22/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
372500000X NVN Nursing Service Related ProvidersChore Provider 
372600000X NVN Nursing Service Related ProvidersAdult Companion 
3747A0650X NVN Nursing Service Related ProvidersTechnicianAttendant Care Provider
376J00000X NVN Nursing Service Related ProvidersHomemaker 
3747P1801X NVY Nursing Service Related ProvidersTechnicianPersonal Care Attendant

No ID Information.


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