Healthcare Provider Details

I. General information

NPI: 1386548329
Provider Name (Legal Business Name): KRYSTAL MARIE LEPAK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17161 W BAJADA RD
SURPRISE AZ
85387-1091
US

IV. Provider business mailing address

32919 N CENTER ST
WITTMANN AZ
85361-9433
US

V. Phone/Fax

Practice location:
  • Phone: 162-328-8280
  • Fax:
Mailing address:
  • Phone: 623-250-7746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number336876
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: