Provider Demographics
NPI:1467298000
Name:MCAVOY, CRYSTAL LEA (LPN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LEA
Last Name:MCAVOY
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 1:1548 DORSET DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-5321
Mailing Address - Country:US
Mailing Address - Phone:317-480-0421
Mailing Address - Fax:
Practice Address - Street 1:1548 DORSET DR
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-5321
Practice Address - Country:US
Practice Address - Phone:317-480-0421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27070664A171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty