Provider Demographics
NPI:1912873415
Name:VISCO WADSWORTH, CRYSTAL MARIE (MSN, CRNP, FNP-C)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MARIE
Last Name:VISCO WADSWORTH
Suffix:
Gender:F
Credentials:MSN, CRNP, FNP-C
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:MARIE
Other - Last Name:WADSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, CRNP, FNP-C
Mailing Address - Street 1:375 SLATE RUN RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6451
Mailing Address - Country:US
Mailing Address - Phone:724-407-8173
Mailing Address - Fax:724-407-8173
Practice Address - Street 1:2828 BROADWAY BLVD STE 1
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-4675
Practice Address - Country:US
Practice Address - Phone:724-407-8173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP034043363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner