Provider Demographics
NPI:1679138366
Name:HUMMEL-MIZER, CHRYSTAL D (QMHS)
Entity Type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:D
Last Name:HUMMEL-MIZER
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:CHRYSTAL
Other - Middle Name:D
Other - Last Name:HUMMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6753 STATE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-4517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:521 BEALL AVE
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-3589
Practice Address - Country:US
Practice Address - Phone:330-601-0720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator