Provider Demographics
NPI:1720567837
Name:GIDDINGS, CRYSTAL SHANEICK (LVN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:SHANEICK
Last Name:GIDDINGS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 PAULA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-3217
Mailing Address - Country:US
Mailing Address - Phone:469-207-9533
Mailing Address - Fax:
Practice Address - Street 1:1010 PAULA DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-3217
Practice Address - Country:US
Practice Address - Phone:469-207-9533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX317119164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse