Provider Demographics
NPI:1669540829
Name:GERMANN, CRYSTAL (PA-C)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:GERMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NEUMANN WAY BLDG 750
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1915
Mailing Address - Country:US
Mailing Address - Phone:513-853-8900
Mailing Address - Fax:513-853-8998
Practice Address - Street 1:1 NEUMANN WAY BLDG 750
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-1915
Practice Address - Country:US
Practice Address - Phone:513-853-8900
Practice Address - Fax:513-853-8998
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-00-2161363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0127403Medicaid
OH0127403Medicaid
OHH321950Medicare PIN