Provider Demographics
NPI:1972864270
Name:ROCK, CRYSTAL GRACE (LPN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:GRACE
Last Name:ROCK
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 1:32 UNDERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-3626
Mailing Address - Country:US
Mailing Address - Phone:518-335-0045
Mailing Address - Fax:
Practice Address - Street 1:32 UNDERWOOD AVE
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-3626
Practice Address - Country:US
Practice Address - Phone:518-335-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296004-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse