MEDICARE: CRYSTAL MCFADDIN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	0024172003	VA

General Provider Information

NPI Number	:	1265836050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL MCFADDIN NP

Provider Business Mailing Address
First Line	:	201 HULL ST. #42
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224
Country	:	US
Telephone Number	:	804-441-5303
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 EAST PARHAM ROAD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23228
Country	:	US
Telephone Number	:	804-501-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2014
Last Update Date	:	10/22/2014

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