Provider Demographics
NPI:1366270100
Name:ROTHBART, CRYSTAL
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:ROTHBART
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 1:21 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN UNIVERSITY
Mailing Address - State:PA
Mailing Address - Zip Code:19352-1320
Mailing Address - Country:US
Mailing Address - Phone:609-705-6524
Mailing Address - Fax:
Practice Address - Street 1:21 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:LINCOLN UNIVERSITY
Practice Address - State:PA
Practice Address - Zip Code:19352-1320
Practice Address - Country:US
Practice Address - Phone:609-705-6524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR240671163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse