Provider Demographics
NPI:1720864580
Name:NIGHTINGALE, CRYSTALYN (BSN, RN, IBCLC)
Entity type:Individual
Prefix:
First Name:CRYSTALYN
Middle Name:
Last Name:NIGHTINGALE
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:NIGHTINGALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN, RN, IBCLC
Mailing Address - Street 1:101 STIRLING DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5116
Mailing Address - Country:US
Mailing Address - Phone:707-761-4880
Mailing Address - Fax:
Practice Address - Street 1:101 STIRLING DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5116
Practice Address - Country:US
Practice Address - Phone:707-761-4880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95081541163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant