Provider Demographics
NPI:1689241671
Name:EDWARDS, CRYSTAL DIAMOND
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DIAMOND
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 1:15380 WEIR ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-5005
Mailing Address - Country:US
Mailing Address - Phone:888-269-9261
Mailing Address - Fax:
Practice Address - Street 1:15380 WEIR ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-5005
Practice Address - Country:US
Practice Address - Phone:888-269-9261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY000423093E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide