Provider Demographics
NPI:1356685226
Name:STAPLETON, CRYSTAL BRANDY (RN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:BRANDY
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8945 N MONTGOMERY COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45322-9646
Mailing Address - Country:US
Mailing Address - Phone:937-901-4306
Mailing Address - Fax:
Practice Address - Street 1:8945 N MONTGOMERY COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:OH
Practice Address - Zip Code:45322-9646
Practice Address - Country:US
Practice Address - Phone:937-901-4306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH347028163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse