Provider Demographics
NPI:1013737733
Name:WHITE, CHRYSTAL MAY (RN)
Entity type:Individual
Prefix:MS
First Name:CHRYSTAL
Middle Name:MAY
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CHRYSTAL
Other - Middle Name:MAY
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:254 PLAINFIELD RD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:WEST LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03784-2001
Mailing Address - Country:US
Mailing Address - Phone:603-392-7615
Mailing Address - Fax:603-298-6284
Practice Address - Street 1:254 PLAINFIELD RD UNIT 4
Practice Address - Street 2:
Practice Address - City:WEST LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03784-2001
Practice Address - Country:US
Practice Address - Phone:603-392-7615
Practice Address - Fax:603-298-6284
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.154151163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)