Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1235881848 |
---|---|
Provider Name | Crystal Sumpter |
First Address | Starke, FL 32091-5563 |
Second Address | Starke, FL 32091-3211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2022 |
Last Update Date | 25/01/2022 |