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General NPI Number Information
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NPI Number | 1699509547
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Entity Type | Individual
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Provider Name | KRYSTAL THOMAS BSN RN IBCLC
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Gender | Female
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Dates
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Enumeration Date | 08/31/2024
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Last Update Date | 08/31/2024
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Provider Practice Location Address
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Address Line | 2756 N 46TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19131-1529
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Country | US
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Telephone | 202-758-6196
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Fax |
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Provider Business Mailing Address
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Address Line | 2756 N 46TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19131-1529
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Country | US
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Telephone |
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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 | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | RN677558
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License Number State | PA
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