Provider Demographics
NPI:1316604820
Name:OLLER, CRYSTAL GAIL (APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:GAIL
Last Name:OLLER
Suffix:
Gender:F
Credentials:APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:949 CANTERBURY LN
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-4390
Mailing Address - Country:US
Mailing Address - Phone:330-853-9367
Mailing Address - Fax:
Practice Address - Street 1:107 JAVIT CT
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2410
Practice Address - Country:US
Practice Address - Phone:330-797-0407
Practice Address - Fax:330-793-1431
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2024-08-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0030289363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics