Provider Demographics
NPI:1720221013
Name:PRESLAR, CRISTY JO (IDMT)
Entity Type:Individual
Prefix:MS
First Name:CRISTY
Middle Name:JO
Last Name:PRESLAR
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 HARRISWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-8841
Mailing Address - Country:US
Mailing Address - Phone:731-334-1271
Mailing Address - Fax:
Practice Address - Street 1:364 ARTHUR DRIVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON AFB
Practice Address - State:SC
Practice Address - Zip Code:29404
Practice Address - Country:US
Practice Address - Phone:843-963-6722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians