Healthcare Provider Details

I. General information

NPI: 1982915237
Provider Name (Legal Business Name): CRYSTAL ALSTON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 W BASELINE RD STE 111
PHOENIX AZ
85041-6492
US

IV. Provider business mailing address

261 N ROOSEVELT AVE
CHANDLER AZ
85226-2617
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-8282
  • Fax: 844-470-2777
Mailing address:
  • Phone: 480-677-8282
  • Fax: 844-470-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number272968
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: