Provider Demographics
NPI:1720679731
Name:MULLIGAN, CRYSTALYNN (CRNP)
Entity Type:Individual
Prefix:
First Name:CRYSTALYNN
Middle Name:
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CRYSTALYNN
Other - Middle Name:
Other - Last Name:DESMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-0907
Mailing Address - Country:US
Mailing Address - Phone:215-453-4995
Mailing Address - Fax:215-453-4646
Practice Address - Street 1:670 LAWN AVE STE 3A
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1571
Practice Address - Country:US
Practice Address - Phone:215-257-9500
Practice Address - Fax:215-257-3578
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN706889363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner