Basic Information
Provider Information
NPI: 1033558515
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SALAZAR
FirstName: CRAYSTAL
MiddleName: GAIL
NamePrefix:  
NameSuffix:  
Credential: RN, CPNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4500 WESLEY ST
Address2:  
City: GREENVILLE
State: TX
PostalCode: 754015644
CountryCode: US
TelephoneNumber: 9034555986
FaxNumber: 9034544621
Practice Location
Address1: 4311 WESLEY ST
Address2:  
City: GREENVILLE
State: TX
PostalCode: 754015639
CountryCode: US
TelephoneNumber: 9034555958
FaxNumber: 9034551604
Other Information
ProviderEnumerationDate: 06/18/2013
LastUpdateDate: 08/12/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200X741134TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics

No ID Information.


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