Provider Demographics
NPI:1477938256
Name:COMBS, CRYSTAL (CNA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:COMBS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 S 250 E
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:IN
Mailing Address - Zip Code:46534-9770
Mailing Address - Country:US
Mailing Address - Phone:574-806-1323
Mailing Address - Fax:
Practice Address - Street 1:4955 E 800 S
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-9537
Practice Address - Country:US
Practice Address - Phone:574-806-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCNA0901181376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide