Provider Demographics
NPI:1598928061
Name:POLSON, CRYSTAL LYNN (NP)
Entity Type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:LYNN
Last Name:POLSON
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 1:888 8TH AVE
Mailing Address - Street 2:6R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5704
Mailing Address - Country:US
Mailing Address - Phone:917-623-1018
Mailing Address - Fax:
Practice Address - Street 1:888 8TH AVE
Practice Address - Street 2:6R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5704
Practice Address - Country:US
Practice Address - Phone:917-623-1018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-05
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430404-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care