Provider Demographics
NPI:1447272075
Name:DONLEY, CRYSTAL L
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:L
Last Name:DONLEY
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 1:68017 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43912-3206
Mailing Address - Country:US
Mailing Address - Phone:740-296-9068
Mailing Address - Fax:
Practice Address - Street 1:68017 WALNUT ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:OH
Practice Address - Zip Code:43912-3206
Practice Address - Country:US
Practice Address - Phone:740-296-9068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2290775Medicaid