Individual
CRYSTAL PENNINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
605 GATEWAY CT, KETCHIKAN, AK 99901-5672
(907) 228-6558
Mailing address
120 CARLANNA LAKE RD, KETCHIKAN, AK 99901-5611
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
22403
AK
363LF0000X
Family Nurse Practitioner
Primary
166689
AK
Other
Enumeration date
12/18/2017
Last updated
12/08/2020
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