Provider Demographics
NPI:1225725518
Name:BALLEW, CRYSTAL CHARIL
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:CHARIL
Last Name:BALLEW
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 1:523 S COOPER AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-4501
Mailing Address - Country:US
Mailing Address - Phone:513-635-3650
Mailing Address - Fax:513-948-0022
Practice Address - Street 1:523 S COOPER AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-4501
Practice Address - Country:US
Practice Address - Phone:513-513-6353
Practice Address - Fax:513-948-0022
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH501142110706376K00000X, 376K00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty