Provider Demographics
NPI:1801149760
Name:CHRISMAN, CRYSTAL
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:CHRISMAN
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 1:1300 COLLEGE AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-1154
Mailing Address - Country:US
Mailing Address - Phone:607-733-4504
Mailing Address - Fax:
Practice Address - Street 1:1300 COLLEGE AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-1154
Practice Address - Country:US
Practice Address - Phone:607-733-4504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2938271164W00000X
NY00293827164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse