Provider Demographics
NPI:1053109074
Name:DUNAWAY, CRYSTAL MARIE
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MARIE
Last Name:DUNAWAY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67925 DUBOIS ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43912-1287
Mailing Address - Country:US
Mailing Address - Phone:740-298-6644
Mailing Address - Fax:
Practice Address - Street 1:67925 DUBOIS ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:OH
Practice Address - Zip Code:43912-1287
Practice Address - Country:US
Practice Address - Phone:740-298-6644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant