Healthcare Provider Details

I. General information

NPI: 1891577888
Provider Name (Legal Business Name): CRISTAL HENZEL BUESCHER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 S 2ND AVE
WALLA WALLA WA
99362-4059
US

IV. Provider business mailing address

3561 OLD MILTON HWY
WALLA WALLA WA
99362-7186
US

V. Phone/Fax

Practice location:
  • Phone: 509-540-1759
  • Fax:
Mailing address:
  • Phone: 509-540-1759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61496612
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: