Individual
CRYSTAL LEAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3540 CROTON AVEENUE, CLEVELAND, OH 44115
(216) 202-1017
(216) 361-1922
Mailing address
3540 CROTON AVE, CLEVELAND, OH 44115-3212
(216) 202-1017
(216) 361-1922
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
164715
OH
Other
Enumeration date
01/05/2022
Last updated
01/05/2022
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