Provider Demographics
NPI:1699920959
Name:BOLAND, CRYSTAL
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:BOLAND
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 1:1456 OAK HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:AUSTINBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44010-9730
Mailing Address - Country:US
Mailing Address - Phone:440-275-1899
Mailing Address - Fax:
Practice Address - Street 1:1456 OAK HOLLOW DR
Practice Address - Street 2:
Practice Address - City:AUSTINBURG
Practice Address - State:OH
Practice Address - Zip Code:44010-9730
Practice Address - Country:US
Practice Address - Phone:440-275-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-28
Last Update Date:2008-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN304497163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health