Provider Demographics
NPI:1326287822
Name:WATERS, CRYSTAL MARIAN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:MARIAN
Last Name:WATERS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 10TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-3406
Mailing Address - Country:US
Mailing Address - Phone:202-526-9028
Mailing Address - Fax:
Practice Address - Street 1:HOWARD UNIVERSITY STUDENT HEALTH CTR
Practice Address - Street 2:2139 GEORGIA AVE. NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20059-0001
Practice Address - Country:US
Practice Address - Phone:202-806-7416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-07
Last Update Date:2009-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN65402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily