Provider Demographics
NPI:1144725763
Name:CASILLAS, CRYSTAL ROSE (LVN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ROSE
Last Name:CASILLAS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 DOLORES PL
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5999
Mailing Address - Country:US
Mailing Address - Phone:940-442-7313
Mailing Address - Fax:
Practice Address - Street 1:5425 DOLORES PL
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-5999
Practice Address - Country:US
Practice Address - Phone:940-442-7313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330946164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse