MEDICARE: CRYSTAL FASSETT FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LC1500X	Community Health Nurse Practitioner	LG-0012236	DE

General Provider Information

NPI Number	:	1306559125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL FASSETT FNP

Provider Business Mailing Address
First Line	:	100 PENN MART SHOPPING CTR
Second Line	:
City	:	NEW CASTLE
State	:	DE
Zip	:	19720-4209
Country	:	US
Telephone Number	:	302-276-0103
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 PENNSYLVANIA AVE STE 1A
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19806-1333
Country	:	US
Telephone Number	:	302-400-9999
Fax Number	:	302-600-3564

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2022
Last Update Date	:	07/31/2025

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