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Individual

CRYSTAL MA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CRNP

Contact information

Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(800) 879-2467
Mailing address
21 N CHATSWORTH AVE, APT 1F, LARCHMONT, NY 10538-2110
(281) 902-6640

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN674320
PA
363LP0200X
Pediatric Nurse Practitioner
Primary
SP017378
PA

Other

Enumeration date
03/30/2017
Last updated
03/30/2017
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