Healthcare Provider Details

I. General information

NPI: 1730583485
Provider Name (Legal Business Name): CRYSTAL DUNIFON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 10/12/2024
Certification Date: 10/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 W HIGH ST STE. 460
LIMA OH
45801-3990
US

IV. Provider business mailing address

PO BOX 636930
CINCINNATI OH
45263-6930
US

V. Phone/Fax

Practice location:
  • Phone: 419-226-4300
  • Fax: 419-226-4305
Mailing address:
  • Phone: 513-981-5123
  • Fax: 513-981-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.16679
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: