Doctor Name: | CRYSTAL GREEN |
NPI Number: | 1639508385 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 316 Pinner St Suffolk, VA - 234343824 |
Business Phone Number: | 7578095316 |
Business Fax Number: | |
Mailing Address: | 316 Pinner St, SUFFOLK |
State: | VA |
Postal Code: | 234343824 |
Phone Number: | 7578095316 |
Fax Number: | |
NPI Enumeration Date: | 11/04/2013 |
NPI Last Update Date: | 01/19/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 385H00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Respite Care Facility |
Taxonomy Classification: | Respite Care |
Taxonomy Specialization: | |
Taxonomy Definition: |