Individual
NANCY J CROUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
601 E FORT ST, FARMINGTON, IL 61531-1338
(309) 647-0201
(309) 649-6880
Mailing address
180 S MAIN ST, CANTON, IL 61520-2608
(309) 647-0201
(309) 649-5101
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209004472
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0062839
UMWA
IL
01
—
02922981
BCBS
IL
01
—
200397
BLACK LUNG
IL
05
—
209004472
—
IL
01
—
CG5172
RR MEDICARE GROUP#
IL
Enumeration date
08/25/2006
Last updated
04/13/2021
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