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General NPI Number Information
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NPI Number | 1144657404
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Entity Type | Individual
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Provider Name | CRYSTAL FAITH CISNEROS NP
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Gender | Female
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Dates
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Enumeration Date | 10/02/2013
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 101 CHRIS KELLEY BLVD
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City | HUTTO
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State | TX
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Zip | 78634-5540
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Country | US
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Telephone | 512-759-3980
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Fax | 512-276-6698
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Provider Business Mailing Address
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Address Line | 705 OAK BRANCH DR
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City | GEORGETOWN
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State | TX
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Zip | 78633-5630
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Country | US
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Telephone | 512-417-8523
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 742176
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License Number State | TX
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