1225438310 NPI number — CHRISTINA M CRANDALL LPN

Table of content: CHRISTINA M CRANDALL LPN (NPI 1225438310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225438310 NPI number — CHRISTINA M CRANDALL LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRANDALL
Provider First Name:
CHRISTINA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225438310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 ASPEN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NARROWSBURG
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12764-5200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-252-7556
Provider Business Mailing Address Fax Number:
570-729-7242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 ASPEN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NARROWSBURG
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12764-5200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-252-7556
Provider Business Practice Location Address Fax Number:
570-729-7242
Provider Enumeration Date:
08/26/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  252233 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 252233 . This is a "NYS LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".