Healthcare Provider Details

I. General information

NPI: 1063011633
Provider Name (Legal Business Name): CRYSTAL UBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 WOODFIELD DR STE 109
GREENVILLE PA
16125-1266
US

IV. Provider business mailing address

750 N COMMONS DR
AURORA IL
60504-7940
US

V. Phone/Fax

Practice location:
  • Phone: 724-588-4957
  • Fax: 724-588-4342
Mailing address:
  • Phone: 630-303-5380
  • Fax: 630-303-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberF03804
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: