Provider Demographics
NPI:1932433232
Name:GIFFORD, CRYSTAL ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:ANN
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SALISBURY AVE
Mailing Address - Street 2:
Mailing Address - City:BLASDELL
Mailing Address - State:NY
Mailing Address - Zip Code:14219-1627
Mailing Address - Country:US
Mailing Address - Phone:716-824-1516
Mailing Address - Fax:
Practice Address - Street 1:1 SALISBURY AVE
Practice Address - Street 2:
Practice Address - City:BLASDELL
Practice Address - State:NY
Practice Address - Zip Code:14219-1627
Practice Address - Country:US
Practice Address - Phone:716-824-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY592060-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse