Provider Demographics
NPI:1356866560
Name:PEREZ, CRYSTAL NICHOLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:NICHOLE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:NICHOLE
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:323 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:KOHLER
Mailing Address - State:WI
Mailing Address - Zip Code:53044-1528
Mailing Address - Country:US
Mailing Address - Phone:262-391-1604
Mailing Address - Fax:
Practice Address - Street 1:323 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:KOHLER
Practice Address - State:WI
Practice Address - Zip Code:53044-1528
Practice Address - Country:US
Practice Address - Phone:262-391-1604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI178894030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health