Individual
DR. CRYSTAL VAUGHN MANSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3 SAINT ELIZABETH BLVD STE 4000, O FALLON, IL 62269-1284
(618) 233-5480
(618) 222-4792
Mailing address
3 SAINT ELIZABETH BLVD, O FALLON, IL 62269-1281
(618) 234-2120
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036139867
IL
208D00000X
General Practice Physician
0101255760
VA
208M00000X
Hospitalist Physician
036139867
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366702870
—
TX
Enumeration date
05/18/2012
Last updated
09/12/2024
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