Provider Demographics
NPI:1154805091
Name:WHITE, CRYSTAL D (LVN)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:D
Last Name:WHITE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 FLAGG RANCH DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-2618
Mailing Address - Country:US
Mailing Address - Phone:832-973-1189
Mailing Address - Fax:
Practice Address - Street 1:6110 FLAGG RANCH DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-2618
Practice Address - Country:US
Practice Address - Phone:832-973-1189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345181164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse