Provider Demographics
NPI:1427291293
Name:TELLIER, KRYSTAL NICOLE (ND, CPM)
Entity type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:NICOLE
Last Name:TELLIER
Suffix:
Gender:F
Credentials:ND, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16601 N 40TH ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3345
Mailing Address - Country:US
Mailing Address - Phone:602-368-9211
Mailing Address - Fax:602-368-9212
Practice Address - Street 1:16601 N 40TH ST
Practice Address - Street 2:SUITE 115
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3345
Practice Address - Country:US
Practice Address - Phone:602-368-9211
Practice Address - Fax:602-368-9212
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ09-1110175F00000X
AZ10090030176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No176B00000XOther Service ProvidersMidwife