Provider Demographics
NPI:1073030516
Name:IWUCHUKWU, CRYSTAL I (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:I
Last Name:IWUCHUKWU
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 BROADWAY ST STE 310
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4556
Mailing Address - Country:US
Mailing Address - Phone:573-381-2081
Mailing Address - Fax:573-331-7849
Practice Address - Street 1:1723 BROADWAY ST STE 310
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4556
Practice Address - Country:US
Practice Address - Phone:573-381-2081
Practice Address - Fax:573-331-7849
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015008652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily