CRYSTAL WILLIS (NPI# 1568813830) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568813830 |
| Entity Type | Individual |
| Full Name | CRYSTAL WILLIS |
| Other Name | CRYSTAL GOINS |
| Credential | LPN |
| Practice Address |
253 Roddy Branch Rd Rockford TN 37853-3108 |
| Practice Telephone | 8656175654 |
| Mailing Telephone | 8656175654 |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2016-06-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 164W00000X | Licensed Practical Nurse | LPN0000082566 | TN | Nursing Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013211911 | Crystal Ann Willis | Rehabilitation Practitioner | 2821 White Peaks Ave, N Las Vegas, NV 89081-2437 | 2011-01-06 |
| 1316459662 | Crystal Willis | Case Manager/Care Coordinator | 150 Cross St, Akron, OH 44311-1026 | 2017-10-26 |
| 1164882320 | Crystal L Willis | Registered Nurse | 2000 Hampton St, Columbia, SC 29204-1002 | 2016-03-02 |
| 1639413966 | Crystal Lynn Willis | Physical Therapy Assistant | 775 Sunset Dr, Athens, GA 30606-2211 | 2012-11-27 |
| 1013289800 | Crystal Danielle Willis | Pharmacist | 2102 W Baker St, Plant City, FL 33563-1643 | 2012-02-08 |
| Street Address |
253 RODDY BRANCH RD |
| City | ROCKFORD |
| State | TN |
| Zip Code | 37853-3108 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467079988 | Michelle Prach | Speech-Language Pathologist | 657 Self Hollow Rd, Rockford, TN 37853 | 2020-06-30 |
| 1710585823 | Purposeful Play Pediatric Therapy Services, Pllc | Speech-Language Pathologist | 657 Self Hollow Rd, Rockford, TN 37853 | 2020-10-12 |
| 1457515280 | Carl Gerald Sundahl | Internal Medicine | 4519 Old Knoxville Hwy, Rockford, TN 37853-3023 | 2008-07-10 |
| 1356733968 | Tiffany Poore | Speech-Language Pathologist | 421 Pine Lakes Ln, Rockford, TN 37853-3201 | 2015-02-19 |
| 1871838656 | Takuo Sonoda | Internal Medicine | 729 Self Hollow Rd, Rockford, TN 37853-3413 | 2012-12-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962002832 | Coleman Clinic, Inc. | Internal Medicine | 1893 Daimler Rd Ste A, Rockford, IL 61112-1081 | 2020-10-29 |
| 1306444070 | Susan Glover | Social Worker | 65 S Main St Lowr Level, Rockford, MI 49341-1286 | 2020-10-14 |
| 1679171433 | Annie Mae Lundgren | Transportation Broker | 7110 Forest Glen Dr Apt F, Rockford, IL 61114-8033 | 2020-10-14 |
| 1902404908 | Christine L Lauer | Dietitian, Registered | 24 Coral Dr Ne, Rockford, MI 49341-8514 | 2020-10-12 |
| 1831797141 | Camelot Care Centers, LLC | Clinic/Center | 5301 E State St Ste 208, Rockford, IL 61108-2397 | 2020-10-09 |
| 1568069805 | Elite Spine & Wellness Center, Inc | Clinic/Center | 5898 Pathfinder Rd, Rockford, IL 61109-4008 | 2020-10-08 |
| 1720685704 | Itzayana Rodriguez | Technician | 5037 Carol Ct, Rockford, IL 61108-4157 | 2020-10-02 |
| 1649886730 | Simply Wellness Chiropractic, LLC | Chiropractor | 7117 Crimson Ridge Dr Ste 1, Rockford, IL 61107-6213 | 2020-09-23 |
| 1689280943 | Servucare Home Care | Home Health | 4803 Javelin Dr, Rockford, IL 61108-2301 | 2020-09-21 |
| 1073129425 | Bradley Theodore Dubey | Physical Therapy Assistant | 6533 Cannon Farms Dr Ne, Rockford, MI 49341-8284 | 2020-09-21 |
| Find all providers in ROCKFORD | ||||
| Taxonomy Code | 164W00000X |
| Grouping | Nursing Service Providers |
| Classification | Licensed Practical Nurse |
| An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states. |
| Notes: Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982225538 | Heidi Lynne Datema | Licensed Practical Nurse | 4499 Summit Forest Dr Ne, Rockford, MI 49341-7842 | 2020-05-05 |
| 1558920975 | Therese Marie Taylor | Licensed Practical Nurse | 148 N Main St Apt 2, Rockford, MI 49341-1016 | 2019-06-10 |
| 1356868277 | Jessica Danae Arreguin | Licensed Practical Nurse | 3121 Rural St, Rockford, IL 61107-3460 | 2017-08-23 |
| 1063881936 | Matthew Field | Licensed Practical Nurse | 6897 Peninsula Dr Ne, Rockford, MI 49341-8790 | 2015-09-21 |
| 1487033643 | Ellen Kuczynski | Licensed Practical Nurse | 6644 Checkerberry Ln Ne, Rockford, MI 49341-8918 | 2015-05-21 |
| 1811332893 | Pamela Jane Moorhead | Licensed Practical Nurse | 12266 Lappley Ave Ne, Rockford, MI 49341-8453 | 2013-05-06 |
| 1871639930 | Silvia M Pike | Licensed Practical Nurse | 528 Washington St, Rockford, IL 61104-1547 | 2007-01-29 |
| 1306883475 | Elizabeth Erin Doorenbos | Licensed Practical Nurse | 6545 13 Mile Rd Ne, Rockford, MI 49341-9714 | 2006-05-31 |
| 1801360201 | Danielle Sladjana Filipov | Licensed Practical Nurse | 3815 Harrison Ave, Rockford, IL 61108-7631 | 2019-01-18 |
| 1891109070 | Mary Anne Martin | Licensed Practical Nurse | 454 N University Dr, Rockford, IL 61107-5323 | 2014-06-16 |
| Find all providers in ROCKFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.