Provider Demographics
NPI:1093265589
Name:BEHM, CHRYSTAL (LPN)
Entity Type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:
Last Name:BEHM
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 1:14 MAIDEN LN
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1208
Mailing Address - Country:US
Mailing Address - Phone:315-531-9102
Mailing Address - Fax:315-531-9103
Practice Address - Street 1:60 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT BYRON
Practice Address - State:NY
Practice Address - Zip Code:13140
Practice Address - Country:US
Practice Address - Phone:315-776-9700
Practice Address - Fax:315-776-9701
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315535164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY315535OtherLICENSE