Individual
MRS. CRYSTAL LORE' CLOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1287 TOWNSHIP ROAD 221, MARENGO, OH 43334-9455
(740) 747-2408
Mailing address
1287 TOWNSHIP ROAD 221, MARENGO, OH 43334-9455
(740) 747-2408
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
0082858
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104665690499
—
OH
Enumeration date
09/04/2014
Last updated
09/04/2014
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