Individual
CRYSTAL LYNN FAGERSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
39 PUNGUK STREET, GOLOVIN, AK 99762
(907) 779-3311
(907) 779-3312
Mailing address
39 PUNGUK STREET, GOLOVIN, AK 99762
(907) 779-3311
(907) 779-3312
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CHA III-C
CHA III-C
AK
Enumeration date
11/26/2014
Last updated
11/26/2014
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