Provider Demographics
NPI:1417660275
Name:SMITH, CRYSTAL N (ADN RN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:N
Last Name:SMITH
Suffix:
Gender:F
Credentials:ADN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 SUNFOREST CT STE 266
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4485
Mailing Address - Country:US
Mailing Address - Phone:419-737-8164
Mailing Address - Fax:419-737-8165
Practice Address - Street 1:3950 SUNFOREST CT STE 266
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4485
Practice Address - Country:US
Practice Address - Phone:419-737-8164
Practice Address - Fax:419-737-8165
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-26
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN493774163WW0000X, 163WH0200X, 163WH1000X
OHRN.493774163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH1000XNursing Service ProvidersRegistered NurseHospice