Provider Demographics
NPI:1760874523
Name:WEIDLE, CRYSTALL (RN, NP-C)
Entity Type:Individual
Prefix:
First Name:CRYSTALL
Middle Name:
Last Name:WEIDLE
Suffix:
Gender:F
Credentials:RN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3143 PATRICK CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-9469
Mailing Address - Country:US
Mailing Address - Phone:513-292-2540
Mailing Address - Fax:
Practice Address - Street 1:3143 PATRICK CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-9469
Practice Address - Country:US
Practice Address - Phone:513-292-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 284411163W00000X
OHCOA-18880 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse