1659490845 NPI number — MRS. CRYSTAL LYNN MORRISON RD, LD, CDE

Table of content: MRS. CRYSTAL LYNN MORRISON RD, LD, CDE (NPI 1659490845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659490845 NPI number — MRS. CRYSTAL LYNN MORRISON RD, LD, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORRISON
Provider First Name:
CRYSTAL
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, LD, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALBERT
Provider Other First Name:
CRYSTAL
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659490845
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 NW LINDEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANKENY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50023-1441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-965-6822
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 LINCOLN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50014-3402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-450-0508
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  01504 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com