Individual
CRYSTAL ALACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N. WHNP
Contact information
Practice address
77 STARBRUSH CIRCLE, COVINGTON, LA 70433
(985) 893-0995
Mailing address
77 STARBRUSH CIRCLE, COVINGTON, LA 70433
(985) 893-0995
(985) 893-8910
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
111536
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111536
NP LICENSE #
LA
Enumeration date
05/08/2014
Last updated
05/08/2014
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