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Individual

CRYSTAL BROADHEAD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
110 W 97TH ST, NEW YORK, NY 10025-6450
(212) 749-1820
Mailing address
75 CUMBERLAND WALK APT 13H, BROOKLYN, NY 11205-2171

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
303542
NY
164W00000X
Licensed Practical Nurse
Primary
303542-1
NY

Other

Enumeration date
12/17/2018
Last updated
12/17/2018
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