Provider Demographics
NPI:1174110654
Name:FRIEND, CRYSTAL GAIL
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:GAIL
Last Name:FRIEND
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 1:739 PENNEROIL RD
Mailing Address - Street 2:
Mailing Address - City:NEW CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26743-7131
Mailing Address - Country:US
Mailing Address - Phone:304-359-0679
Mailing Address - Fax:304-788-6363
Practice Address - Street 1:739 PENNEROIL RD
Practice Address - Street 2:
Practice Address - City:NEW CREEK
Practice Address - State:WV
Practice Address - Zip Code:26743-7131
Practice Address - Country:US
Practice Address - Phone:304-359-0679
Practice Address - Fax:304-788-6363
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant