Provider Demographics
NPI:1477780872
Name:ECHOLS, CRYSTAL LYNN (LVN)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:LYNN
Last Name:ECHOLS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MISS
Other - First Name:CRYSTAL
Other - Middle Name:LYNN
Other - Last Name:SHUMAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9890 COUNTY FARM ROAD, SUITE 3
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503
Mailing Address - Country:US
Mailing Address - Phone:951-509-8320
Mailing Address - Fax:
Practice Address - Street 1:9890 COUNTY FARM ROAD, SUITE 3
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503
Practice Address - Country:US
Practice Address - Phone:951-509-8320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2020-01-24
Deactivation Date:2020-01-08
Deactivation Code:
Reactivation Date:2020-01-24
Provider Licenses
StateLicense IDTaxonomies
OH117695164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse