Healthcare Provider Details

I. General information

NPI: 1922050533
Provider Name (Legal Business Name): CRYSTAL LYNN CRABTREE
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 W MILL ST APT 101B
CARBONDALE IL
62901-4907
US

IV. Provider business mailing address

PO BOX 280
CAMBRIA IL
62915-0280
US

V. Phone/Fax

Practice location:
  • Phone: 618-457-7434
  • Fax:
Mailing address:
  • Phone: 618-697-4261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: