Provider Demographics
NPI:1639660418
Name:RYDALCH, CRYSTAL ANNETTE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANNETTE
Last Name:RYDALCH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:ANNETTE
Other - Last Name:CHATFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 N WOLFE AVE
Mailing Address - Street 2:
Mailing Address - City:EDWARDS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:93524-6201
Mailing Address - Country:US
Mailing Address - Phone:661-277-7118
Mailing Address - Fax:
Practice Address - Street 1:55 N WOLFE AVE
Practice Address - Street 2:
Practice Address - City:EDWARDS AFB
Practice Address - State:CA
Practice Address - Zip Code:93524-2227
Practice Address - Country:US
Practice Address - Phone:616-277-7118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-28
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.018127363LF0000X
WAAP61171748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily