Provider Demographics
NPI:1992031876
Name:HALE, CRYSTAL RAY (CRNA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:RAY
Last Name:HALE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213
Mailing Address - Country:US
Mailing Address - Phone:304-586-9868
Mailing Address - Fax:
Practice Address - Street 1:41 BAKER ST
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:WV
Practice Address - Zip Code:25213
Practice Address - Country:US
Practice Address - Phone:304-586-9868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV54389367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered