Provider Demographics
NPI:1659663144
Name:HOLSTEIN, CRYSTAL R (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:R
Last Name:HOLSTEIN
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1547
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25326-1547
Mailing Address - Country:US
Mailing Address - Phone:304-388-1724
Mailing Address - Fax:304-388-1721
Practice Address - Street 1:4111 1ST AVE STE 3
Practice Address - Street 2:
Practice Address - City:NITRO
Practice Address - State:WV
Practice Address - Zip Code:25143-1345
Practice Address - Country:US
Practice Address - Phone:304-755-4797
Practice Address - Fax:304-755-4799
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2019-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WVAPRN62776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily