Individual
KRYSTLE BANZUELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
6360 W 159TH ST, SUITE A & B, OAK FOREST, IL 60452
(708) 687-4620
Mailing address
8810 1/2 AUSTIN AVE, OAK LAWN, IL 60453
(708) 655-2427
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209011993
IL
Other
Enumeration date
12/05/2014
Last updated
12/05/2014
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