Russo, Crystal L

Russo, Crystal L is an individual health care provider with primary practice located at 900 E Broadway Ave , Bismarck ND 58501-4520. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Russo, Crystal L can be contacted via phone (701) 530-6500.

Contact Information

Primary practice address
900 E Broadway Ave Bismarck ND 58501-4520
Phone: (701) 530-6500
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PAC0582 North Dakota

Profile Details

NPI number 1902094584
LBN Legal business name Russo, Crystal L
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 9th, 2007
Last updated Jul 22nd, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902094584 NPPES
North Dakota MEDICAID 1463523

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