Provider Demographics
NPI:1104700129
Name:HARRIS, CRYSTAL DANEEN
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:DANEEN
Last Name:HARRIS
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 1:2131 APPLE DR
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1612
Mailing Address - Country:US
Mailing Address - Phone:216-402-8351
Mailing Address - Fax:
Practice Address - Street 1:2131 APPLE DR
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44143-1612
Practice Address - Country:US
Practice Address - Phone:216-402-8351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty