Provider Demographics
NPI:1770382566
Name:SIMONTON, CRYSTAL LEE
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LEE
Last Name:SIMONTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:NE
Mailing Address - Zip Code:68932-0036
Mailing Address - Country:US
Mailing Address - Phone:402-756-8028
Mailing Address - Fax:
Practice Address - Street 1:157 E. DOYLE ST.
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:NE
Practice Address - Zip Code:68932
Practice Address - Country:US
Practice Address - Phone:402-756-8028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider