Healthcare Provider Details

I. General information

NPI: 1225805641
Provider Name (Legal Business Name): CRYSTAL D EVANS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 TREELINE PARK
SAN ANTONIO TX
78209-2042
US

IV. Provider business mailing address

1522 W KINGS HWY
SAN ANTONIO TX
78201-5138
US

V. Phone/Fax

Practice location:
  • Phone: 210-294-8000
  • Fax:
Mailing address:
  • Phone: 210-901-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number984069
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: