Provider Demographics
NPI:1699574475
Name:CRISS, QUALYN R
Entity type:Individual
Prefix:
First Name:QUALYN
Middle Name:R
Last Name:CRISS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 AIRPORT HWY APT 4
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-7141
Mailing Address - Country:US
Mailing Address - Phone:567-377-2619
Mailing Address - Fax:
Practice Address - Street 1:3113 PARKWOOD AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43610-1616
Practice Address - Country:US
Practice Address - Phone:419-442-7982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker