Provider Demographics
NPI:1922398551
Name:SHANNON, CRYSTAL LUCILLE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:LUCILLE
Last Name:SHANNON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 CARLYSLE ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-2963
Mailing Address - Country:US
Mailing Address - Phone:336-965-0946
Mailing Address - Fax:
Practice Address - Street 1:698 CARLYSLE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-2963
Practice Address - Country:US
Practice Address - Phone:336-965-0946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-16
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN124501164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse