Healthcare Provider Details

I. General information

NPI: 1184950255
Provider Name (Legal Business Name): CRYSTAL MULLINS FINK CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CRYSTAL MULLINS MUSSELMAN CPM, LM

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 ELECTRIC RD STE 1
ROANOKE VA
24018-1621
US

IV. Provider business mailing address

1950 ELECTRIC RD STE 1
ROANOKE VA
24018-1621
US

V. Phone/Fax

Practice location:
  • Phone: 540-676-7288
  • Fax: 540-301-1768
Mailing address:
  • Phone: 540-676-7288
  • Fax: 540-301-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0129000050
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: