Provider Demographics
NPI:1932776267
Name:SHOFFNER-HARRIS, CRYSTAL DEMETRUS
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:DEMETRUS
Last Name:SHOFFNER-HARRIS
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:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:27298-0637
Mailing Address - Country:US
Mailing Address - Phone:336-549-1081
Mailing Address - Fax:
Practice Address - Street 1:3341 OAK TREE LN
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:27298-9554
Practice Address - Country:US
Practice Address - Phone:336-622-4536
Practice Address - Fax:336-622-1420
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant