Provider Demographics
NPI:1861073744
Name:MERCHANT, KRYSTAL (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 E 100TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-1683
Mailing Address - Country:US
Mailing Address - Phone:773-319-7272
Mailing Address - Fax:
Practice Address - Street 1:3015 HAROLDS CRES
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2009
Practice Address - Country:US
Practice Address - Phone:708-420-6057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041410747163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse