Healthcare Provider Details

I. General information

NPI: 1730802570
Provider Name (Legal Business Name): KRYSTYNE DANYELL MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1577 E CHEVY CHASE DR STE 300
GLENDALE CA
91206-4092
US

IV. Provider business mailing address

1577 E CHEVY CHASE DR STE 300
GLENDALE CA
91206-4092
US

V. Phone/Fax

Practice location:
  • Phone: 818-939-4040
  • Fax:
Mailing address:
  • Phone: 818-939-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95022462
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP1700X
TaxonomyPerinatal Nurse Practitioner
License NumberNP95022462
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP95022462
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP95022462
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberNP95022462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: