Provider Demographics
NPI:1588416929
Name:HAENEL, KRYSTAL LEE
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:LEE
Last Name:HAENEL
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 1:8845 JACKSON RUN RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:16350-5035
Mailing Address - Country:US
Mailing Address - Phone:814-706-8169
Mailing Address - Fax:
Practice Address - Street 1:207 FOOTE AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-7077
Practice Address - Country:US
Practice Address - Phone:716-487-0141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula