Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Family |
363LF0000X | 50 | Nurse Practitioner | |
Primary Care |
261QP2300X |
| NPI # | 1477176824 |
| LBN Legal business name | CRYSTALCARE |
| Authorized official | CRYSTAL WILSON - (OWNER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 05/20/2020 |
| Last updated | 11/18/2020 - About 6 years ago |
| Identifiers | n/a |
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