Provider Demographics
NPI:1336836360
Name:BURNS, CRYSTAL A
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:A
Last Name:BURNS
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 1:925 7TH NORTH ST APT B46
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-7103
Mailing Address - Country:US
Mailing Address - Phone:989-424-9757
Mailing Address - Fax:
Practice Address - Street 1:925 7TH NORTH ST APT B46
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-7103
Practice Address - Country:US
Practice Address - Phone:989-424-9757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist