NPI | 1124486089 |
---|---|
Former Name | CRYSTAL A CISZEK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11020853) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN209456) |
Enumeration Date | 2016-02-08 |
Last Update Date | 2022-09-05 |