Provider Demographics
NPI:1962005181
Name:CALENDINE, CRYSTAL
Entity Type:Individual
Prefix:PROF
First Name:CRYSTAL
Middle Name:
Last Name:CALENDINE
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 1:10824 N REX RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ROCK
Mailing Address - State:OH
Mailing Address - Zip Code:43720-9604
Mailing Address - Country:US
Mailing Address - Phone:740-651-3192
Mailing Address - Fax:
Practice Address - Street 1:10824 N REX RD
Practice Address - Street 2:
Practice Address - City:BLUE ROCK
Practice Address - State:OH
Practice Address - Zip Code:43720-9604
Practice Address - Country:US
Practice Address - Phone:740-651-3192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0113701374U00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide