Individual
CRYSTAL WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
520 TUGGLE RD, PROSPECT, VA 23960-7919
(434) 509-5235
(434) 223-1423
Mailing address
520 TUGGLE RD, PROSPECT, VA 23960-7919
(434) 509-5235
(434) 223-1423
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
0001290756
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001290756
LICENSE
VA
Enumeration date
05/13/2021
Last updated
05/13/2021
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