Provider Demographics
NPI:1306672175
Name:VOLLSTAEDT, CRYSTAL M (LPN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:VOLLSTAEDT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4924 SMITHS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MI
Mailing Address - Zip Code:48074-3910
Mailing Address - Country:US
Mailing Address - Phone:810-357-2437
Mailing Address - Fax:
Practice Address - Street 1:4924 SMITHS CREEK RD
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:MI
Practice Address - Zip Code:48074-3910
Practice Address - Country:US
Practice Address - Phone:810-357-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703092603164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse