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General NPI Number Information
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NPI Number | 1972470748
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Entity Type | Individual
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Provider Name | FIONNA LEI CRISOSTOMO
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Gender | Female
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Dates
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Enumeration Date | 10/17/2025
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 2430 OSPREY WAY STE C
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City | FREDERICK
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State | MD
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Zip | 21701-1957
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Country | US
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Telephone | 240-931-0660
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Fax |
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Provider Business Mailing Address
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Address Line | 6002 FORUM SQ
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City | FREDERICK
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State | MD
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Zip | 21703-2889
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R244586
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License Number State | MD
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