Provider Demographics
NPI:1245516533
Name:MOORMAN, CRYSTAL NICHOLE
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:NICHOLE
Last Name:MOORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9517 MEADOW FALLS DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-4525
Mailing Address - Country:US
Mailing Address - Phone:562-313-1832
Mailing Address - Fax:
Practice Address - Street 1:9517 MEADOW FALLS DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-4525
Practice Address - Country:US
Practice Address - Phone:562-313-1832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220849164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse