Provider Demographics
NPI:1518117654
Name:RHODES, CRYSTAL MICHELLE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:MICHELLE
Last Name:RHODES
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 1:107 GREENKILL AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5441
Mailing Address - Country:US
Mailing Address - Phone:184-533-9668
Mailing Address - Fax:
Practice Address - Street 1:107 GREENKILL AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5441
Practice Address - Country:US
Practice Address - Phone:184-533-9668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2738668-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse