Basic Information
| Provider Information | |||||||||
| NPI: | 1558974105 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERMANO | ||||||||
| FirstName: | CRYSTAL | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 243 BUENA VISTA AVE APT 1102 | ||||||||
| Address2: | |||||||||
| City: | SUNNYVALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940864870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5712011880 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11800 SUNRISE VALLEY DR STE 700 | ||||||||
| Address2: | |||||||||
| City: | RESTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201915315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038341473 | ||||||||
| FaxNumber: | 7033187463 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2020 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 0024179728 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.