Provider Demographics
NPI:1265393854
Name:PHILIP, CRYSTAL KALARITHARA (FNP-BC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:KALARITHARA
Last Name:PHILIP
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 N KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1334
Mailing Address - Country:US
Mailing Address - Phone:630-242-0671
Mailing Address - Fax:
Practice Address - Street 1:802 N KENILWORTH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-1334
Practice Address - Country:US
Practice Address - Phone:630-242-0671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-21
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041448598363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner