Provider Demographics
NPI:1043800048
Name:TELLY, CRYSTAL LEANN (CNA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LEANN
Last Name:TELLY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24630 E APPLEWOOD CIR UNIT 832
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-3925
Mailing Address - Country:US
Mailing Address - Phone:720-227-7882
Mailing Address - Fax:
Practice Address - Street 1:24630 E APPLEWOOD CIR UNIT 832
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-3925
Practice Address - Country:US
Practice Address - Phone:720-227-7882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONA.00761794376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide