Provider Demographics
NPI:1699493999
Name:FERNANDEZ, CRIMSON JEWEL
Entity type:Individual
Prefix:MS
First Name:CRIMSON
Middle Name:JEWEL
Last Name:FERNANDEZ
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 1:4926 BECKER DR APT YY
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-7356
Mailing Address - Country:US
Mailing Address - Phone:269-605-9136
Mailing Address - Fax:
Practice Address - Street 1:4926 BECKER DR APT YY
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-7356
Practice Address - Country:US
Practice Address - Phone:269-605-9136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician