Provider Demographics
NPI:1447952650
Name:JENNESS-TEMPLE, CRYSTAL (RN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:JENNESS-TEMPLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 AMSDEN RD
Mailing Address - Street 2:
Mailing Address - City:CORINNA
Mailing Address - State:ME
Mailing Address - Zip Code:04928-3325
Mailing Address - Country:US
Mailing Address - Phone:207-416-8402
Mailing Address - Fax:
Practice Address - Street 1:16 AMSDEN RD
Practice Address - Street 2:
Practice Address - City:CORINNA
Practice Address - State:ME
Practice Address - Zip Code:04928-3325
Practice Address - Country:US
Practice Address - Phone:207-416-8402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN80293163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health