Provider Demographics
NPI:1942775127
Name:MCLILLEY, CRYSTAL CHIFFON (RN)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:CHIFFON
Last Name:MCLILLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 SAVANNAH LN
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-3600
Mailing Address - Country:US
Mailing Address - Phone:734-796-0847
Mailing Address - Fax:
Practice Address - Street 1:1699 SAVANNAH LN
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-3600
Practice Address - Country:US
Practice Address - Phone:734-796-0847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704289381163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty