Provider Demographics
NPI:1770217531
Name:ANDERSON, CRYSTAL L
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:L
Last Name:ANDERSON
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 1:510 KENDIS CIR APT D
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-4759
Mailing Address - Country:US
Mailing Address - Phone:330-719-7565
Mailing Address - Fax:
Practice Address - Street 1:510 KENDIS CIR APT D
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-4759
Practice Address - Country:US
Practice Address - Phone:330-719-7565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide