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Individual
MARY ANNA CRISOSTOMO
Active
Individual
MARY ANNA CRISOSTOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
209010499
IL
363LP0200X
Pediatric Nurse Practitioner
28172140
IN
363LP0200X
Pediatric Nurse Practitioner
71003821B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201044660
—
IN
Enumeration date
07/15/2008
Last updated
03/17/2018
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