Provider Demographics
NPI:1225438310
Name:CRANDALL, CHRISTINA M (LPN)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:CRANDALL
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 1:15 ASPEN WAY
Mailing Address - Street 2:
Mailing Address - City:NARROWSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12764-5200
Mailing Address - Country:US
Mailing Address - Phone:845-252-7556
Mailing Address - Fax:570-729-7242
Practice Address - Street 1:15 ASPEN WAY
Practice Address - Street 2:
Practice Address - City:NARROWSBURG
Practice Address - State:NY
Practice Address - Zip Code:12764-5200
Practice Address - Country:US
Practice Address - Phone:845-252-7556
Practice Address - Fax:570-729-7242
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252233164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY252233OtherNYS LICENSE