Provider Demographics
NPI:1174834709
Name:LOBE, CRYSTAL LEE (CFNP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LEE
Last Name:LOBE
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:LEE
Other - Last Name:PETTINELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:5219 SAINT JOHN DR
Mailing Address - Street 2:
Mailing Address - City:ORR
Mailing Address - State:MN
Mailing Address - Zip Code:55771-8232
Mailing Address - Country:US
Mailing Address - Phone:218-757-3431
Mailing Address - Fax:
Practice Address - Street 1:5219 SAINT JOHN DR
Practice Address - Street 2:
Practice Address - City:ORR
Practice Address - State:MN
Practice Address - Zip Code:55771-8232
Practice Address - Country:US
Practice Address - Phone:218-757-3431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR179208-7363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily