Provider Demographics
NPI:1275894974
Name:WARE, CRYSTAL EVELYN (LPN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:EVELYN
Last Name:WARE
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 1:24455 LAKE SHORE BLVD #1810
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1273
Mailing Address - Country:US
Mailing Address - Phone:216-659-0881
Mailing Address - Fax:
Practice Address - Street 1:24455 LAKE SHORE BLVD APT 1810
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1278
Practice Address - Country:US
Practice Address - Phone:216-659-0881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH142081-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse