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NPI Code Detail

MEDICARE: ELIZABETH CRYSTAL PLOENSE MS

MEDICARE: ELIZABETH CRYSTAL PLOENSE MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1962027904
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH CRYSTAL PLOENSE MS
Provider Business Mailing Address
First Line : 5403 VICTORIA AVE
Second Line :
City : DAVENPORT
State : IA
Zip : 52807-3925
Country : US
Telephone Number : 563-296-0877
Fax Number :
Provider Business Practice Location Address
First Line : 5403 VICTORIA AVE
Second Line :
City : DAVENPORT
State : IA
Zip : 52807-3925
Country : US
Telephone Number : 563-296-0877
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2020
Last Update Date : 12/30/2024

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Directions to “ ELIZABETH CRYSTAL PLOENSE MS” Practice Location

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