Basic Information
| Provider Information | |||||||||
| NPI: | 1033558515 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALAZAR | ||||||||
| FirstName: | CRAYSTAL | ||||||||
| MiddleName: | GAIL | ||||||||
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| Credential: | RN, CPNP | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 741134 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.