=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518754332
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRYSTAL SADLER PLANCK FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2025
-----------------------------------------------------
Last Update Date | 01/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1309 BRENTWAY AVE
-----------------------------------------------------
City | WILLIAMSTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27892-7593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-362-3660
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 342 PINE RIDGE RD
-----------------------------------------------------
City | WINDSOR
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27983-8134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-325-4769
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 5022040
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 217922
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------