Provider Demographics
NPI:1649829243
Name:DEL ROSARIO, KRYSTAL MARIE (RN)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:MARIE
Last Name:DEL ROSARIO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:MARIE
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:14618 17TH AVENUE CT S
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-9074
Mailing Address - Country:US
Mailing Address - Phone:253-431-2438
Mailing Address - Fax:
Practice Address - Street 1:14618 17TH AVENUE CT S
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-9074
Practice Address - Country:US
Practice Address - Phone:253-431-2438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60327145163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse