Provider Demographics
NPI:1417660275
Name:SMITH, CRYSTAL N (ADN RN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:N
Last Name:SMITH
Suffix:
Gender:F
Credentials:ADN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 SUNFOREST CT STE 266
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4485
Mailing Address - Country:US
Mailing Address - Phone:419-341-0243
Mailing Address - Fax:
Practice Address - Street 1:3420 KIRBY PL
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-1324
Practice Address - Country:US
Practice Address - Phone:419-214-8403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-26
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.493774163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice