Provider Demographics
NPI:1467222430
Name:HOWARD, CRYSTAL (RN, RA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:RN, RA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 E MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1951
Mailing Address - Country:US
Mailing Address - Phone:585-455-6497
Mailing Address - Fax:
Practice Address - Street 1:117 E MAPLE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1951
Practice Address - Country:US
Practice Address - Phone:585-455-6497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY572227163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse