Individual
CRYSTAL ROLLEG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
P-T0929
AR
363AM0700X
Medical Physician Assistant
Primary
PA10274
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1P1862
MEDICARE
TX
Enumeration date
10/15/2009
Last updated
06/28/2021
Update your record
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