| NPI | 1720241482 |
|---|---|
| Former Name | KRYSTAL MARIE GENNARIA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 16548) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 567327) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2008-07-02 |