Provider Demographics
NPI:1093949661
Name:CRITCHELL, CRISTY KATHLEEN
Entity Type:Individual
Prefix:
First Name:CRISTY
Middle Name:KATHLEEN
Last Name:CRITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45403-2937
Mailing Address - Country:US
Mailing Address - Phone:937-245-2554
Mailing Address - Fax:
Practice Address - Street 1:27 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-2937
Practice Address - Country:US
Practice Address - Phone:937-245-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide