Provider Demographics
NPI:1245037175
Name:VINSON, CRYSTAL S
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:S
Last Name:VINSON
Suffix:
Gender:
Credentials:
Other - Prefix:MS
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:VINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48068-0065
Mailing Address - Country:US
Mailing Address - Phone:248-632-4488
Mailing Address - Fax:
Practice Address - Street 1:4315 JUDSON AVE APT J1
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6561
Practice Address - Country:US
Practice Address - Phone:248-632-4488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care