Provider Demographics
NPI:1093068983
Name:CRISAFULLI, JUSTINE A (RN)
Entity Type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:A
Last Name:CRISAFULLI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 LORALEE DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-2223
Mailing Address - Country:US
Mailing Address - Phone:518-869-3576
Mailing Address - Fax:518-869-6481
Practice Address - Street 1:102 LORALEE DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-2223
Practice Address - Country:US
Practice Address - Phone:518-869-3576
Practice Address - Fax:518-869-6481
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320009163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse