Provider Demographics
NPI:1912480039
Name:TRABEL, CRYSTAL M
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:TRABEL
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 1:208 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43526-1299
Mailing Address - Country:US
Mailing Address - Phone:419-542-6692
Mailing Address - Fax:
Practice Address - Street 1:208 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43526-1299
Practice Address - Country:US
Practice Address - Phone:419-542-6692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008632A363LF0000X
OHAPRN.CNP.023623363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily