Provider Demographics
NPI:1013250513
Name:ABBOTT, JOAN C (RN)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:C
Last Name:ABBOTT
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 1:6461 - LYNDALE AVE SO
Mailing Address - Street 2:CRYSTAL CARE HOME HEALTH
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423
Mailing Address - Country:US
Mailing Address - Phone:612-861-4272
Mailing Address - Fax:612-605-0078
Practice Address - Street 1:6461 - LYNDALE AVE SO
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423
Practice Address - Country:US
Practice Address - Phone:612-861-4272
Practice Address - Fax:612-605-0078
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR105642-2163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse