Provider Demographics
NPI:1417497207
Name:SWEENEY, CRYSTAL ANN (LPN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANN
Last Name:SWEENEY
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 1:12115 MCCRACKEN RD
Mailing Address - Street 2:B204
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2961
Mailing Address - Country:US
Mailing Address - Phone:216-856-2232
Mailing Address - Fax:
Practice Address - Street 1:12115 MCCRACKEN RD
Practice Address - Street 2:B204
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2961
Practice Address - Country:US
Practice Address - Phone:216-856-0232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH158680164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse