Individual provider Active NPI

Gordon Bennett Cromwell III

  • Licensed Vocational Nurse
  • Fresno, CA
National Provider Identifier
1083183784
Registry record updated Nov 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Vocational NurseTaxonomy code 164X00000X
License
VN257768 Issued in CA
Practice address
3103 E Cartwright Ave
Fresno, CA 93725-9385
Phone
(559) 498-7100
Fax
(559) 498-7111
NPI assigned
Nov 26, 2018
Last updated
Nov 26, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Vocational Nurse 164X00000X VN257768 CA Primary

Addresses

Primary practice location

3103 E Cartwright Ave
Fresno, CA 93725-9385

Mailing address

3103 E Cartwright Ave
Fresno, CA 93725-9385
Phone (559) 498-7100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
VN257768CAMDLicensed Vocational Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1543190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543190400000",
    "number": "1083183784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3103 E CARTWRIGHT AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937259385",
            "telephone_number": "559-498-7100",
            "fax_number": "559-498-7111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3103 E CARTWRIGHT AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937259385",
            "telephone_number": "559-498-7100",
            "fax_number": "559-498-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROMWELL",
        "first_name": "GORDON",
        "middle_name": "BENNETT",
        "name_suffix": "III",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-26",
        "last_updated": "2018-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "VN257768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.