Provider Demographics
NPI:1033558515
Name:SALAZAR, CRAYSTAL GAIL (RN, CPNP)
Entity Type:Individual
Prefix:
First Name:CRAYSTAL
Middle Name:GAIL
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 WESLEY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-5644
Mailing Address - Country:US
Mailing Address - Phone:903-455-5986
Mailing Address - Fax:903-454-4621
Practice Address - Street 1:4311 WESLEY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5639
Practice Address - Country:US
Practice Address - Phone:903-455-5958
Practice Address - Fax:903-455-1604
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX741134363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics