Provider Demographics
NPI:1336573443
Name:FOOCE, CHRYSTAL LYNN (LPN)
Entity Type:Individual
Prefix:MS
First Name:CHRYSTAL
Middle Name:LYNN
Last Name:FOOCE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 MILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:43162-1524
Mailing Address - Country:US
Mailing Address - Phone:614-879-6418
Mailing Address - Fax:
Practice Address - Street 1:46 MILL RD
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:43162-1524
Practice Address - Country:US
Practice Address - Phone:614-879-6418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH153553164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse