Individual
MS. CRYSTAL CHANEL DILLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
13 POLK CT, CORAM, NY 11727-3915
(631) 732-0787
Mailing address
13 POLK CT, CORAM, NY 11727-3915
(631) 732-0787
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
308880-1
NY
Other
Enumeration date
04/09/2012
Last updated
04/09/2012
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