Provider Demographics
NPI:1306559125
Name:FASSETT, CRYSTAL (FNP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:FASSETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PENN MART SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-4209
Mailing Address - Country:US
Mailing Address - Phone:302-276-0103
Mailing Address - Fax:
Practice Address - Street 1:100 PENN MART SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-4209
Practice Address - Country:US
Practice Address - Phone:302-276-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0012236363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health