Provider Demographics
NPI:1902588254
Name:TAYLOR, CRYSTAL E (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:E
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:CRYSTAL
Other - Middle Name:E
Other - Last Name:EXHEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1017 MARIETTA AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-3105
Mailing Address - Country:US
Mailing Address - Phone:757-718-3555
Mailing Address - Fax:
Practice Address - Street 1:701 TIDEWATER DR FL 2
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3323
Practice Address - Country:US
Practice Address - Phone:757-510-8984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002093319164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse