Provider Demographics
NPI:1043522147
Name:CRISS, ELIZA M (LPN)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:M
Last Name:CRISS
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 1:5903 S US HIGHWAY 23
Mailing Address - Street 2:
Mailing Address - City:ALVADA
Mailing Address - State:OH
Mailing Address - Zip Code:44802-9729
Mailing Address - Country:US
Mailing Address - Phone:419-889-7923
Mailing Address - Fax:
Practice Address - Street 1:5903 S US HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:ALVADA
Practice Address - State:OH
Practice Address - Zip Code:44802-9729
Practice Address - Country:US
Practice Address - Phone:419-889-7923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN114723164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse