Provider Demographics
NPI:1144992124
Name:DALLOO, CRYSTAL (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:DALLOO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28595 ORCHARD LAKE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2979
Mailing Address - Country:US
Mailing Address - Phone:248-553-0010
Mailing Address - Fax:248-553-5957
Practice Address - Street 1:28595 ORCHARD LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2979
Practice Address - Country:US
Practice Address - Phone:248-553-0010
Practice Address - Fax:248-553-5957
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704342831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily