Provider Demographics
NPI:1124177209
Name:CHRYST, NICOLE BRIANNE (LMP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:BRIANNE
Last Name:CHRYST
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:BRIANNA
Other - Last Name:LAPRAIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5728
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98509-5728
Mailing Address - Country:US
Mailing Address - Phone:360-539-7726
Mailing Address - Fax:360-539-7729
Practice Address - Street 1:1017 4TH AVE E
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4016
Practice Address - Country:US
Practice Address - Phone:360-539-7726
Practice Address - Fax:360-539-7729
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022961174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist