Provider Demographics
NPI:1033401484
Name:MORIN, CRYSTAL GUAY (CNM)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:GUAY
Last Name:MORIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MISS
Other - First Name:CRYSTAL
Other - Middle Name:NICOLE
Other - Last Name:GUAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-749-4963
Mailing Address - Fax:
Practice Address - Street 1:15 OLD ROLLINSFORD RD STE 102
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820
Practice Address - Country:US
Practice Address - Phone:603-749-4963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH061519-23367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3111822Medicaid