Provider Demographics
NPI:1174051544
Name:TOWNSEND, CRYSTAL OCTAVIA
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:OCTAVIA
Last Name:TOWNSEND
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 2882
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27515-2882
Mailing Address - Country:US
Mailing Address - Phone:919-748-2680
Mailing Address - Fax:
Practice Address - Street 1:2505 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-9087
Practice Address - Country:US
Practice Address - Phone:858-360-5807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC292984376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide