Healthcare Provider Details

I. General information

NPI: 1437515772
Provider Name (Legal Business Name): KRYSTEL LAZZARI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 SPRINGHILL MEMORIAL DR N
MOBILE AL
36608-1162
US

IV. Provider business mailing address

114 ASBURY HILL RD
DAPHNE AL
36526-9742
US

V. Phone/Fax

Practice location:
  • Phone: 251-410-3600
  • Fax: 251-410-3700
Mailing address:
  • Phone: 251-656-3397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF1215504
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: