Individual
CRYSTAL S JESENICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.N.P.-C
Contact information
Practice address
922 TALON DR, SUITE B, O FALLON, IL 62269-1848
(618) 972-5641
(314) 270-5283
Mailing address
825 SAYBROOK FALLS DR, FAIRVIEW HEIGHTS, IL 62208-2168
(618) 972-5641
(314) 270-5283
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
209006003
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
427014204
—
MO
Enumeration date
10/05/2006
Last updated
10/16/2015
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