Provider Demographics
NPI:1215657457
Name:RODRIGUEZ, KRYSTAL NICHOLE (LPN)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:NICHOLE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8687 E VIA DE VENTURA STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3351
Mailing Address - Country:US
Mailing Address - Phone:490-609-9000
Mailing Address - Fax:
Practice Address - Street 1:8687 E VIA DE VENTURA STE 110
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3351
Practice Address - Country:US
Practice Address - Phone:480-609-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR222393164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse