Provider Demographics
NPI:1679242374
Name:EDWARDS, CRYSTAL J
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:J
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3052 BALCONES FAULT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6409
Mailing Address - Country:US
Mailing Address - Phone:702-236-6158
Mailing Address - Fax:
Practice Address - Street 1:3052 BALCONES FAULT AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-6409
Practice Address - Country:US
Practice Address - Phone:702-236-6158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant