Organization
CRYSTAL LYNN COLE PMHNP-BC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL LYNN COLE PMHNP (OWNER)
(224) 306-1879
Entity
Organization
Contact information
Practice address
2500 W BRADLEY PL STE 100, CHICAGO, IL 60618-4716
(224) 306-1879
(224) 205-3757
Mailing address
PO BOX 506, NORTHBROOK, IL 60065-0506
(847) 562-9505
(847) 282-1669
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12756649
CAQH
—
Enumeration date
02/26/2020
Last updated
02/26/2020
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