Provider Demographics
NPI:1467809533
Name:WEISE, CRYSTAL (CRNP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:WEISE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:MEININGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 MEADOW CREEK DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-9426
Mailing Address - Country:US
Mailing Address - Phone:410-848-0707
Mailing Address - Fax:
Practice Address - Street 1:410 MEADOW CREEK DR
Practice Address - Street 2:SUITE 209
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21158-9426
Practice Address - Country:US
Practice Address - Phone:410-848-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR196134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily