Doctor Name: | CRYSTAL KEITH |
NPI Number: | 1265859417 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 92436 |
Business Practice Address: | 508 Cactus Ct Lugoff, SC - 290788816 |
Business Phone Number: | 8034844180 |
Business Fax Number: | 8034844580 |
Mailing Address: | 508 Cactus Ct, LUGOFF |
State: | SC |
Postal Code: | 290788816 |
Phone Number: | 8034844180 |
Fax Number: | 8034844580 |
NPI Enumeration Date: | 03/26/2014 |
NPI Last Update Date: | 03/26/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WC1500X |
License Number: | 92436 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Community Health |
Taxonomy Definition: |