Provider Demographics
NPI:1750927893
Name:MINOR, CRYSTAL LYNNETTE (WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LYNNETTE
Last Name:MINOR
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 SE INDUSTRY DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-5023
Mailing Address - Country:US
Mailing Address - Phone:252-492-8576
Mailing Address - Fax:
Practice Address - Street 1:1209 SE INDUSTRY DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-5023
Practice Address - Country:US
Practice Address - Phone:252-492-8576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMINO-A511SW363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health