Crystal Martinez-Jacome, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN.510218 Issued in OH

Practice address

761 15TH St SE
Massillon, OH 44646-8256

Phone

(330) 245-6443

NPI assigned

Sep 9, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Crystal Moldovan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1567987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656201600000",
    "number": "1477102747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1258",
            "city": "MASSILLON",
            "state": "OH",
            "postal_code": "446481258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "761 15TH ST SE",
            "city": "MASSILLON",
            "state": "OH",
            "postal_code": "446468256",
            "telephone_number": "330-245-6443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ-JACOME",
        "first_name": "CRYSTAL",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-09",
        "last_updated": "2022-06-26",
        "certification_date": "2022-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "LPN.171745.MEDS-IV",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN.510218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRYSTAL",
            "last_name": "MOLDOVAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jaime Marino-Freetage, MA, CCC-SLP
• Derek H Marion, COTA
• Michael L Markel, M.D.
• Melissa Katheryn Marsh, OTR/L
• Vicki Lynn Marshall
• Sara Marty, RN
• Massillon Cable TV Inc
• Massillon Cable TV, Inc
• Massillon City School District
• Massillon Counseling Services

• Registered Nurse in Massillon, OH
• Providers in Massillon, OH by specialty
• Registered Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.