Healthcare Provider Details

I. General information

NPI: 1174155303
Provider Name (Legal Business Name): CRYSTAL MARIE O'NEILL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 KEMPSVILLE CIR
NORFOLK VA
23502-3933
US

IV. Provider business mailing address

608 SANTIAGO CT
CHESAPEAKE VA
23323-6679
US

V. Phone/Fax

Practice location:
  • Phone: 757-354-2885
  • Fax:
Mailing address:
  • Phone: 360-389-6473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178818
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: