Individual
CRYSTAL CHICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPC-NP-BC
Contact information
Practice address
4901 LANG AVE NE, ALBUQUERQUE, NM 87109-4397
(505) 842-8171
(505) 246-0684
Mailing address
4901 LANG AVE NE, ALBUQUERQUE, NM 87109-4397
(505) 842-8171
(505) 246-0684
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0995019-NP
CO
363L00000X
Nurse Practitioner
Primary
63441
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
63789337
—
NM
05
—
9000178403
—
CO
Enumeration date
09/20/2019
Last updated
05/18/2022
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