Healthcare Provider Details

I. General information

NPI: 1578334280
Provider Name (Legal Business Name): CRYSTAL LUO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAI LUO

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9930 EVERGREEN WAY STE Z150
EVERETT WA
98204-3889
US

IV. Provider business mailing address

9930 EVERGREEN WAY STE Z150
EVERETT WA
98204-3889
US

V. Phone/Fax

Practice location:
  • Phone: 425-347-5121
  • Fax:
Mailing address:
  • Phone: 425-347-5121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61604064
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: