Provider Demographics
NPI:1063999233
Name:CARPENTER-STEWART, CRYSTAL NICOLE (CNA/GNA)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:NICOLE
Last Name:CARPENTER-STEWART
Suffix:
Gender:F
Credentials:CNA/GNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3538 MCSHANE WAY
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-5957
Mailing Address - Country:US
Mailing Address - Phone:443-210-6815
Mailing Address - Fax:
Practice Address - Street 1:3538 MCSHANE WAY
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-5957
Practice Address - Country:US
Practice Address - Phone:443-210-6815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty