Provider Demographics
NPI:1104118322
Name:WEESNER, CRYSTAL JEAN (RN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:JEAN
Last Name:WEESNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22731 STEVENSON RD
Mailing Address - Street 2:
Mailing Address - City:RIDGELY
Mailing Address - State:MD
Mailing Address - Zip Code:21660-1311
Mailing Address - Country:US
Mailing Address - Phone:410-829-1001
Mailing Address - Fax:410-634-2506
Practice Address - Street 1:22731 STEVENSON RD
Practice Address - Street 2:
Practice Address - City:RIDGELY
Practice Address - State:MD
Practice Address - Zip Code:21660-1311
Practice Address - Country:US
Practice Address - Phone:410-829-1001
Practice Address - Fax:410-634-2506
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR190758163W00000X
DCRN1019895163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse