Provider Demographics
NPI:1760748446
Name:NIZAR, KRYSTAL W (MD, PHD)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:W
Last Name:NIZAR
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:W
Other - Last Name:CHIAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:450 HIGHWAY 1 W # 115
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-4204
Mailing Address - Country:US
Mailing Address - Phone:319-435-1720
Mailing Address - Fax:620-670-8407
Practice Address - Street 1:450 HIGHWAY 1 W # 115
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-4204
Practice Address - Country:US
Practice Address - Phone:319-435-1720
Practice Address - Fax:620-670-8407
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1267832084P0800X
IAMD-458922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry