Provider Demographics
NPI:1396222998
Name:WALLS, CRYSTAL LYNNE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LYNNE
Last Name:WALLS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3017
Mailing Address - Country:US
Mailing Address - Phone:403-627-2792
Mailing Address - Fax:240-362-7096
Practice Address - Street 1:WESTERN MARYLAND HEALTH SYSTEM
Practice Address - Street 2:12500 WILLOWBROOK RD
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502
Practice Address - Country:US
Practice Address - Phone:240-964-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR156273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily