Provider Demographics
NPI:1285223230
Name:WATSON, CRYSTAL LYNN
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LYNN
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17678 HANNAN TRACE RD
Mailing Address - Street 2:
Mailing Address - City:CROWN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45623-9015
Mailing Address - Country:US
Mailing Address - Phone:740-645-1678
Mailing Address - Fax:
Practice Address - Street 1:17678 HANNAN TRACE RD
Practice Address - Street 2:
Practice Address - City:CROWN CITY
Practice Address - State:OH
Practice Address - Zip Code:45623-9015
Practice Address - Country:US
Practice Address - Phone:740-645-1678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant