Provider Demographics
NPI:1619678703
Name:ZIEGLER, CRYSTAL D (STNA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:D
Last Name:ZIEGLER
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 COUNTY RD W
Mailing Address - Street 2:
Mailing Address - City:LIBERTY CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43532-9765
Mailing Address - Country:US
Mailing Address - Phone:419-906-2449
Mailing Address - Fax:
Practice Address - Street 1:753 WAUSEON SENIOR VILLAGE DR
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-2229
Practice Address - Country:US
Practice Address - Phone:419-335-6544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X, 376K00000X, 251E00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH602618250323OtherSTNA