Provider Demographics
NPI:1982161337
Name:WARD, CRYSTAL JOHANNA (NP)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:JOHANNA
Last Name:WARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:JOHANNA
Other - Last Name:LAHTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:707-595-2685
Mailing Address - Fax:
Practice Address - Street 1:2350 MENDOCINO AVE
Practice Address - Street 2:STE A4
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403
Practice Address - Country:US
Practice Address - Phone:707-595-2685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011971363LF0000X
CA95091676163W00000X
VA0024183153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse