Provider Demographics
NPI:1275378085
Name:WANZER, CHRYSTAL ADRIAN
Entity type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:ADRIAN
Last Name:WANZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 LAMONT ST NW UNIT 135
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1781
Mailing Address - Country:US
Mailing Address - Phone:240-462-1736
Mailing Address - Fax:
Practice Address - Street 1:1715 HOLBROOK ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2507
Practice Address - Country:US
Practice Address - Phone:202-489-1372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant