Provider Demographics
NPI:1073259263
Name:MACHATERRE, CRYSTAL M (LPN)
Entity Type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:M
Last Name:MACHATERRE
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 1:5244 SUDER AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43611-1457
Mailing Address - Country:US
Mailing Address - Phone:567-288-1331
Mailing Address - Fax:
Practice Address - Street 1:5244 SUDER AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611-1457
Practice Address - Country:US
Practice Address - Phone:567-288-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH132674164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse