Provider Demographics
NPI:1366760316
Name:WEINER, CRYSTAL (LPN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:WEINER
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 1:97 RITA CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1719
Mailing Address - Country:US
Mailing Address - Phone:614-483-8201
Mailing Address - Fax:
Practice Address - Street 1:97 RITA CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1719
Practice Address - Country:US
Practice Address - Phone:614-483-8201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN138727-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse