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General NPI Number Information
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NPI Number | 1790126837
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Entity Type | Individual
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Provider Name | CRYSTAL SUE HAMBLEY FNP
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Gender | Female
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 5200 FAIRVIEW BLVD
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City | WYOMING
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State | MN
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Zip | 55092-8013
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Country | US
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Telephone | 651-982-7000
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Fax | 651-982-7110
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Provider Business Mailing Address
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Address Line | PO BOX 875743
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City | KANSAS CITY
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State | MO
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Zip | 64187-5743
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Country | US
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Telephone | 913-215-5008
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Fax | 816-447-3960
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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 | 220700
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License Number State | NC
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