Provider Demographics
NPI:1376982512
Name:JOO, KRYSTAL CHOI (NP)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:CHOI
Last Name:JOO
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 1:1045 PELTO PATH
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-9205
Mailing Address - Country:US
Mailing Address - Phone:651-303-5106
Mailing Address - Fax:
Practice Address - Street 1:1045 PELTO PATH
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-9205
Practice Address - Country:US
Practice Address - Phone:651-303-5106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAG0613039363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner