Provider Demographics
NPI:1245677137
Name:NEELY, CRYSTAL LEE (LPN)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:LEE
Last Name:NEELY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:CRYSTAL
Other - Middle Name:LEE
Other - Last Name:MOWRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1440 LEXINGTON DR
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-1558
Mailing Address - Country:US
Mailing Address - Phone:440-320-4335
Mailing Address - Fax:
Practice Address - Street 1:1440 LEXINGTON DR
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089
Practice Address - Country:US
Practice Address - Phone:440-320-4335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.140864.MEDS-IV164W00000X, 251J00000X
OH140864164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No251J00000XAgenciesNursing Care