Provider Demographics
NPI:1306399183
Name:OWENS, CRYSTAL ELISHA
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ELISHA
Last Name:OWENS
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 1:9815 GOOD LUCK RD # 201
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3359
Mailing Address - Country:US
Mailing Address - Phone:202-361-4256
Mailing Address - Fax:
Practice Address - Street 1:5103 43RD AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781-2039
Practice Address - Country:US
Practice Address - Phone:336-266-4236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide