Individual
CRYSTAL NICHOLE DAVERN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
8 DEEPWOOD CT, DEPEW, NY 14043-4244
(716) 715-7004
Mailing address
8 DEEPWOOD CT, DEPEW, NY 14043-4244
(716) 715-7004
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
3206371
NY
Other
Enumeration date
03/08/2018
Last updated
03/08/2018
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