Provider Demographics
NPI:1528682036
Name:DONLEY, KRYSTAL ZAMORA (RN, MSN, PMHNP)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:ZAMORA
Last Name:DONLEY
Suffix:
Gender:F
Credentials:RN, MSN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19820 N 7TH ST STE 140
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-1691
Mailing Address - Country:US
Mailing Address - Phone:623-487-7763
Mailing Address - Fax:602-900-4057
Practice Address - Street 1:19820 N 7TH ST STE 140
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-1691
Practice Address - Country:US
Practice Address - Phone:623-487-7763
Practice Address - Fax:602-900-4057
Is Sole Proprietor?:No
Enumeration Date:2020-05-31
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN161161163W00000X
AZRNP247561363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse