Doctor Name: | CRYSTAL LARGE |
NPI Number: | 1568709129 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 0024170577 |
Business Practice Address: | 517 W Main St Suite E Wise, VA - 242936905 |
Business Phone Number: | 2763282961 |
Business Fax Number: | 2763282965 |
Mailing Address: | Po Box 3077, WISE |
State: | VA |
Postal Code: | 242933077 |
Phone Number: | 2763282961 |
Fax Number: | 2763282965 |
NPI Enumeration Date: | 01/15/2013 |
NPI Last Update Date: | 01/15/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 0024170577 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |