Provider Demographics
NPI:1932889318
Name:FLORES-ALAMO, CRYSTAL SHANICE (FNP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:SHANICE
Last Name:FLORES-ALAMO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11048 W VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6755
Mailing Address - Country:US
Mailing Address - Phone:208-546-8175
Mailing Address - Fax:
Practice Address - Street 1:1145 S 12TH ST EXT
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-3406
Practice Address - Country:US
Practice Address - Phone:208-642-3396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID58974363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care