Provider Demographics
NPI:1063113421
Name:FURTICK-VEST, CRYSTAL LOUISE (ARNP FNP-BC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LOUISE
Last Name:FURTICK-VEST
Suffix:
Gender:F
Credentials:ARNP FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 CAPITAL MALL DR SW APT B103
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8668
Mailing Address - Country:US
Mailing Address - Phone:360-470-2212
Mailing Address - Fax:
Practice Address - Street 1:3200 CAPITAL MALL DR SW APT B103
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8668
Practice Address - Country:US
Practice Address - Phone:360-470-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60565655163W00000X
WAAP61420525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse