Provider Demographics
NPI:1497072672
Name:POLAND, CRYSTAL RENEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:RENEE
Last Name:POLAND
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 1:166 HARPER ST
Mailing Address - Street 2:
Mailing Address - City:NEW CONCORD
Mailing Address - State:OH
Mailing Address - Zip Code:43762-1107
Mailing Address - Country:US
Mailing Address - Phone:740-260-4127
Mailing Address - Fax:
Practice Address - Street 1:166 HARPER ST
Practice Address - Street 2:
Practice Address - City:NEW CONCORD
Practice Address - State:OH
Practice Address - Zip Code:43762-1107
Practice Address - Country:US
Practice Address - Phone:740-260-4127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH117150164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse