Healthcare Provider Details

I. General information

NPI: 1427141506
Provider Name (Legal Business Name): CRYSTAL TOPEL LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CRYSTAL DAY LM

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 GROVE AVE
WINTER PARK FL
32789-3651
US

IV. Provider business mailing address

434 GROVE AVE
WINTER PARK FL
32789-3651
US

V. Phone/Fax

Practice location:
  • Phone: 407-644-5567
  • Fax:
Mailing address:
  • Phone: 407-644-5567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW194
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: