| Doctor Name: | CRYSTAL H KOHISTANI |
| NPI Number: | 1275943821 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C, MPAS |
| License Number: | PA176406 |
| Business Practice Address: | 335 Fairview St Silverton, OR - 973811916 |
| Business Phone Number: | 5038738686 |
| Business Fax Number: | 5038738689 |
| Mailing Address: | 335 Fairview St, SILVERTON |
| State: | OR |
| Postal Code: | 973811916 |
| Phone Number: | 5038738686 |
| Fax Number: | 5038738689 |
| NPI Enumeration Date: | 05/05/2014 |
| NPI Last Update Date: | 05/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA176406 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |