Provider Demographics
NPI:1952818502
Name:FRANCK, CRYSTAL LOVE (RD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LOVE
Last Name:FRANCK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 OAKES AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-5010
Mailing Address - Country:US
Mailing Address - Phone:206-276-2644
Mailing Address - Fax:
Practice Address - Street 1:4030 ALDERWOOD MALL BLVD
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6763
Practice Address - Country:US
Practice Address - Phone:425-776-0803
Practice Address - Fax:425-776-0803
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00988663133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
00988663OtherRD/RDN
WA60815340OtherCD