Individual
CRYSTAL WRAPE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CASE MANAGER II
Contact information
Practice address
2425 W UNIVERSITY BLVD STE 100, DURANT, OK 74701-2970
(580) 924-7331
(580) 924-7332
Mailing address
1976 COUNTY ROAD 4236, BONHAM, TX 75418-9535
(903) 815-3958
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100728830A
—
OK
Enumeration date
05/14/2020
Last updated
05/14/2020
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