Healthcare Provider Details

I. General information

NPI: 1568053098
Provider Name (Legal Business Name): CRYSTAL COREN LEE COOK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL COREN LEE APRN, PMHNP-BC

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W NORFOLK AVE STE 201
NORFOLK NE
68701-5221
US

IV. Provider business mailing address

333 W NORFOLK AVE STE 201
NORFOLK NE
68701-5221
US

V. Phone/Fax

Practice location:
  • Phone: 402-379-2030
  • Fax: 402-379-3933
Mailing address:
  • Phone: 402-379-2030
  • Fax: 402-379-3933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number113455
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: