Provider Demographics
NPI:1801102579
Name:WOODS, CRYSTAL JUNE (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:JUNE
Last Name:WOODS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 W SONGER LN
Mailing Address - Street 2:
Mailing Address - City:VEEDERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47987-8547
Mailing Address - Country:US
Mailing Address - Phone:765-762-4180
Mailing Address - Fax:765-764-4181
Practice Address - Street 1:440 W SONGER LN
Practice Address - Street 2:
Practice Address - City:VEEDERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47987-8547
Practice Address - Country:US
Practice Address - Phone:765-762-4180
Practice Address - Fax:765-764-4181
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003286B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201021400Medicaid