Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1184231094 |
---|---|
Provider Name | Crystal Ashley Callaway |
First Address | Oak Park, MI 48237-1166 |
Second Address | Bingham Farms, MI 48025-2454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2020 |
Last Update Date | 24/09/2020 |