Healthcare Provider Details

I. General information

NPI: 1518442946
Provider Name (Legal Business Name): CHRYSTAL EUSTACE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 CR 3435
PARADISE TX
76073
US

IV. Provider business mailing address

342 CR 3435
PARADISE TX
76073
US

V. Phone/Fax

Practice location:
  • Phone: 940-389-5619
  • Fax:
Mailing address:
  • Phone: 940-389-5619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number819154
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: