MEDICARE: CRYSTAL MINTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1609994128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL MINTON

Provider Business Mailing Address
First Line	:	PO BOX 563
Second Line	:
City	:	NEW VIENNA
State	:	OH
Zip	:	45159-0563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11192 ST. RT.73 SOUTH
Second Line	:
City	:	NEW VIENNA
State	:	OH
Zip	:	45159-0563
Country	:	US
Telephone Number	:	937-987-0729
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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Directions to “ CRYSTAL MINTON ” Practice Location

Language	Start Address	Practice Location

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