Provider Demographics
NPI:1164069001
Name:BOSTIC, CRISTY DIANNA (CAREGIVER)
Entity Type:Individual
Prefix:MRS
First Name:CRISTY
Middle Name:DIANNA
Last Name:BOSTIC
Suffix:
Gender:F
Credentials:CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6644 LIST ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-6419
Mailing Address - Country:US
Mailing Address - Phone:330-417-3234
Mailing Address - Fax:
Practice Address - Street 1:6644 LIST ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-6419
Practice Address - Country:US
Practice Address - Phone:330-417-3234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider