| NPI | 1598044034 | 
|---|---|
| Former Name | CRYSTAL RENEA BRANDON | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704213325) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11016360) | 
| Enumeration Date | 2011-08-16 | 
| Last Update Date | 2024-12-18 |