Provider Demographics
NPI:1639785819
Name:MARCHESE, CRYSTALYN (DNP, FNP)
Entity Type:Individual
Prefix:
First Name:CRYSTALYN
Middle Name:
Last Name:MARCHESE
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:CRYSTALYN
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP
Mailing Address - Street 1:333 N SUMMIT ST FL 7
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1215 GRASSY LN
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1525
Practice Address - Country:US
Practice Address - Phone:419-661-9727
Practice Address - Fax:419-661-9730
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704301942363LF0000X
OHAPRN.CNP.0032572363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily