Provider Demographics
NPI:1386378719
Name:MCNACK, CRYSTAL (RN)
Entity type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:
Last Name:MCNACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 OVERTON AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-1821
Mailing Address - Country:US
Mailing Address - Phone:816-210-2650
Mailing Address - Fax:
Practice Address - Street 1:19000 E EASTLAND CENTER CT STE 200
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7023
Practice Address - Country:US
Practice Address - Phone:816-478-9299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018006875163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health