Healthcare Provider Details

I. General information

NPI: 1619678703
Provider Name (Legal Business Name): CRYSTAL D ZIEGLER STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 WAUSEON SENIOR VILLAGE DR
WAUSEON OH
43567-2229
US

IV. Provider business mailing address

6675 COUNTY RD W
LIBERTY CENTER OH
43532-9765
US

V. Phone/Fax

Practice location:
  • Phone: 419-335-6544
  • Fax:
Mailing address:
  • Phone: 419-906-2449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: