Healthcare Provider Details

I. General information

NPI: 1114407301
Provider Name (Legal Business Name): CRYSTAL LUNA MSN, APRN-RX, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL BISQUERA

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2245 NE ALLIE AVE STE 19
HILLSBORO OR
97124-9078
US

IV. Provider business mailing address

17358 SW CURTIS LN
BEAVERTON OR
97007-2200
US

V. Phone/Fax

Practice location:
  • Phone: 808-469-7619
  • Fax:
Mailing address:
  • Phone: 808-469-7619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201802814NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: