Provider Demographics
NPI:1376054692
Name:BOLTON, CRYSTAL (CNM)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:BOLTON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 CLIFTON AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-3041
Mailing Address - Country:US
Mailing Address - Phone:513-751-5900
Mailing Address - Fax:
Practice Address - Street 1:3219 CLIFTON AVE STE 210
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-3041
Practice Address - Country:US
Practice Address - Phone:513-751-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH019347176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife