Provider Demographics
NPI:1396571188
Name:SALLEE, CRYSTAL
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:SALLEE
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 1:3920 IRELAND RD
Mailing Address - Street 2:
Mailing Address - City:COOLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45723-9740
Mailing Address - Country:US
Mailing Address - Phone:740-541-6603
Mailing Address - Fax:
Practice Address - Street 1:3920 IRELAND RD
Practice Address - Street 2:
Practice Address - City:COOLVILLE
Practice Address - State:OH
Practice Address - Zip Code:45723-9740
Practice Address - Country:US
Practice Address - Phone:740-541-6603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN370944376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide