Provider Demographics
NPI:1609549633
Name:ALEXANDER, CRYSTAL (AGPCNP-BC, RN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:AGPCNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 FREELAND RD APT 73
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-9619
Mailing Address - Country:US
Mailing Address - Phone:989-928-4629
Mailing Address - Fax:
Practice Address - Street 1:2770 FREELAND RD APT 73
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9619
Practice Address - Country:US
Practice Address - Phone:989-928-4629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704263539163W00000X
MI2021104539363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse