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General NPI Number Information
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NPI Number | 1992520621
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Entity Type | Individual
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Provider Name | CRYSTAL ORTIZ
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Gender | Female
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 2070 N IL-50 500
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City | BOURBONNAIS
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State | IL
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Zip | 60914
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Country | US
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Telephone | 779-236-4094
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Fax |
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Provider Business Mailing Address
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Address Line | 21364 WILLOW PASS
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City | SHOREWOOD
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State | IL
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Zip | 60404-8237
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Country | US
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Telephone | 630-312-0348
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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 | 209031084
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License Number State | IL
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