Provider Demographics
NPI:1376834341
Name:ALLEN, CRYSTAL LORRAINE (LPN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LORRAINE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LPN
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 134
Mailing Address - Street 2:
Mailing Address - City:WEST MANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45382-0134
Mailing Address - Country:US
Mailing Address - Phone:937-529-9231
Mailing Address - Fax:
Practice Address - Street 1:308 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST MANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45382-0134
Practice Address - Country:US
Practice Address - Phone:937-529-9231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.102493164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse