| NPI | 1770962532 |
|---|---|
| Former Name | CRYSTAL LEANN SOUTHERLAND |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA 61630988) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 20030) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2025-05-14 |