Provider Demographics
NPI:1053047357
Name:GARY, CHRYSTELLE MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CHRYSTELLE
Middle Name:MARIE
Last Name:GARY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20158 NW 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-1777
Mailing Address - Country:US
Mailing Address - Phone:786-223-8893
Mailing Address - Fax:
Practice Address - Street 1:20158 NW 35TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-1777
Practice Address - Country:US
Practice Address - Phone:561-316-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5219276164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse