Basic Information
| Provider Information | |||||||||
| NPI: | 1659739936 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DENSMORE | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5196 GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | BOWMANSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140261038 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5196 GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | BOWMANSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140261038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166811895 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2016 | ||||||||
| LastUpdateDate: | 07/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | P00752 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 019539 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.