Provider Demographics
NPI:1346652823
Name:BRYANT-FREEMAN, CRYSTAL (NP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:BRYANT-FREEMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 WESTGATE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1451
Mailing Address - Country:US
Mailing Address - Phone:612-262-7800
Mailing Address - Fax:612-262-7022
Practice Address - Street 1:910 E 26TH ST
Practice Address - Street 2:SUITE 100-200
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4526
Practice Address - Country:US
Practice Address - Phone:612-884-6300
Practice Address - Fax:612-884-6363
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-162122-6363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care