Provider Demographics
NPI:1619122496
Name:SCOTT, CRYSTAL D (LPN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:D
Last Name:SCOTT
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 1:899 COUNTY ROUTE 48
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13144-4456
Mailing Address - Country:US
Mailing Address - Phone:315-298-3786
Mailing Address - Fax:
Practice Address - Street 1:899 COUNTY ROUTE 48
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:NY
Practice Address - Zip Code:13144-4456
Practice Address - Country:US
Practice Address - Phone:315-298-3786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244116164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse