Active NPI
Debra Rosemary Crookendale, MSN RN
- Rehabilitation Registered Nurse
- Baldwin, NY
National Provider Identifier
1093496549
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Registered Nurse
- License
- 568460
- Practice address
- 3472 Bertha Dr
Baldwin, NY 11510-5052 - Phone
- (845) 777-5835
- NPI assigned
- Jul 27, 2023
- Last updated
- Aug 4, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 15
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Administrator Registered Nurse | 163WA2000X | 568460 | NY | |
| Critical Care Medicine Registered Nurse | 163WC0200X | 568460 | NY | |
| Continence Care Registered Nurse | 163WC2100X | 568460 | NY | |
| Cardiac Rehabilitation Registered Nurse | 163WC3500X | 568460 | NY | |
| Diabetes Educator Registered Nurse | 163WD0400X | 568460 | NY | |
| Peritoneal Dialysis Registered Nurse | 163WD1100X | 568460 | NY | |
| Enterostomal Therapy Registered Nurse | 163WE0900X | 568460 | NY | |
| Gerontology Registered Nurse | 163WG0600X | 568460 | NY | |
| Home Health Registered Nurse | 163WH0200X | 568460 | NY | |
| Infusion Therapy Registered Nurse | 163WI0500X | 568460 | NY | |
| Medical-Surgical Registered Nurse | 163WM0705X | 568460 | NY | |
| Pain Management Registered Nurse | 163WP0000X | 568460 | NY | |
| Adult Psychiatric/Mental Health Registered Nurse | 163WP0809X | 568460 | NY | |
| Rehabilitation Registered Nurse | 163WR0400X | 568460 | NY | Primary |
| Urology Registered Nurse | 163WU0100X | 568460 | NY |
Addresses
Primary practice location
3472 Bertha Dr
Baldwin, NY 11510-5052
Mailing address
3472 Bertha Dr
Baldwin, NY 11510-5052
Phone (845) 777-5835
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
- Credentials
- Master of Science - Nursing, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 568460 | NY | MD | Peritoneal Dialysis Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691107200000",
"number": "1093496549",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3472 BERTHA DR",
"city": "BALDWIN",
"state": "NY",
"postal_code": "115105052",
"telephone_number": "845-777-5835"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3472 BERTHA DR",
"city": "BALDWIN",
"state": "NY",
"postal_code": "115105052",
"telephone_number": "845-777-5835"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROOKENDALE",
"first_name": "DEBRA",
"middle_name": "ROSEMARY",
"name_prefix": "Miss",
"credential": "MSN RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-07-27",
"last_updated": "2023-08-04",
"certification_date": "2023-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "163WA2000X",
"taxonomy_group": "",
"desc": "Registered Nurse, Administrator",
"state": "NY",
"license": "568460",
"primary": false
},
{
"code": "163WC0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Critical Care Medicine",
"state": "NY",
"license": "568460",
"primary": false
},
{
"code": "163WC2100X",
"taxonomy_group": "",
"desc": "Registered Nurse, Continence Care",
"state": "NY",
"license": "568460",
"primary": false
},
{
"code": "163WC3500X",
"taxonomy_group": "",
"desc": "Registered Nurse, Cardiac Rehabilitation",
"state": "NY",
"license": "568460",
"primary": false
},
{
"code": "163WD0400X",
"taxonomy_group": "",
"desc": "Registered Nurse, Diabetes Educator",
"state": "NY",
"license": "568460",
"primary": false
},
{
"code": "163WD1100X",
"taxonomy_group": "",
"desc": "Registered Nurse, Dialysis, Peritoneal",
"state": "NY",
"license": "568460",
"primary": false
},
{
"code": "163WE0900X",
"taxonomy_group": "",
"desc": "Registered Nurse, Enterostomal Therapy",
"state": "NY",
"license": "568460",
"primary": false
},
{
"code": "163WG0600X",
"taxonomy_group": "",
"desc": "Registered Nurse, Gerontology",
"state": "NY",
"license": "568460",
"primary": false
},
{
"code": "163WH0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Home Health",
"state": "NY",
"license": "568460",
"primary": false
},
{
"code": "163WI0500X",
"taxonomy_group": "",
"desc": "Registered Nurse, Infusion Therapy",
"state": "NY",
"license": "568460",
"primary": false
},
{
"code": "163WM0705X",
"taxonomy_group": "",
"desc": "Registered Nurse, Medical-Surgical",
"state": "NY",
"license": "568460",
"primary": false
},
{
"code": "163WP0000X",
"taxonomy_group": "",
"desc": "Registered Nurse, Pain Management",
"state": "NY",
"license": "568460",
"primary": false
},
{
"code": "163WP0809X",
"taxonomy_group": "",
"desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
"state": "NY",
"license": "568460",
"primary": false
},
{
"code": "163WR0400X",
"taxonomy_group": "",
"desc": "Registered Nurse, Rehabilitation",
"state": "NY",
"license": "568460",
"primary": true
},
{
"code": "163WU0100X",
"taxonomy_group": "",
"desc": "Registered Nurse, Urology",
"state": "NY",
"license": "568460",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baldwin, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.