Provider Demographics
NPI:1407355746
Name:UPTAIN, CRYSTAL (CNM)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:UPTAIN
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 1:981 WOOSTER RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-1536
Mailing Address - Country:US
Mailing Address - Phone:330-674-1015
Mailing Address - Fax:330-763-8679
Practice Address - Street 1:151 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-8949
Practice Address - Country:US
Practice Address - Phone:330-674-2822
Practice Address - Fax:330-674-1200
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNM.019359176B00000X
OHAPRN.CNP.024836363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No176B00000XOther Service ProvidersMidwife