Individual
CRYSTAL LOOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1705 WARREN AVE, SUITE 101103, WILLIAMSPORT, PA 17701-2647
(570) 321-2020
Mailing address
1201 GRAMPIAN BLVD, SUITE 101103, WILLIAMSPORT, PA 17701-1900
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
MA056962
PA
Other
Enumeration date
07/25/2014
Last updated
05/24/2021
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