Provider Demographics
NPI:1205018108
Name:STEARNS, CRYSTAL CERISE (RNC, IBCLC,RLC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:CERISE
Last Name:STEARNS
Suffix:
Gender:F
Credentials:RNC, IBCLC,RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:LONE GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:73443-0321
Mailing Address - Country:US
Mailing Address - Phone:580-657-4148
Mailing Address - Fax:580-220-6884
Practice Address - Street 1:1011 14TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1828
Practice Address - Country:US
Practice Address - Phone:580-220-6432
Practice Address - Fax:580-220-6884
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist