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General NPI Number Information
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NPI Number | 1114648912
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Entity Type | Individual
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Provider Name | CRYSTAL NELSON CLC
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Gender | Female
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Dates
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Enumeration Date | 09/09/2022
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Last Update Date | 01/27/2023
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Provider Practice Location Address
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Address Line | 276 SOUND BEACH AVE FL 2
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City | OLD GREENWICH
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State | CT
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Zip | 06870-1621
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Country | US
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Telephone | 541-390-8649
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Fax |
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Provider Business Mailing Address
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Address Line | 1686 W ANTLER AVE
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City | REDMOND
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State | OR
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Zip | 97756-1917
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Country | US
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Telephone | 541-390-8649
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | 332546
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License Number State | OR
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