Individual
CRYSTAL DAWN EAVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1604 N WASHINGTON AVE, DURANT, OK 74701-2128
(580) 920-0909
(580) 931-3119
Mailing address
1604 N WASHINGTON AVE, DURANT, OK 74701-2128
(580) 920-0909
(580) 931-3119
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10
PRIVATE PAY
OK
Enumeration date
08/14/2013
Last updated
08/14/2013
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