Individual
MS. CRYSTAL MICHELLE WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
8014 CORY AVE, CLEVELAND, OH 44103-3436
(216) 862-2210
Mailing address
8014 CORY AVE, CLEVELAND, OH 44103-3436
(216) 862-2210
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN.141935
OH
Other
Enumeration date
02/01/2011
Last updated
02/01/2011
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