Provider Demographics
NPI:1073372330
Name:HALGRIMSON, CRYSTA KAE
Entity Type:Individual
Prefix:
First Name:CRYSTA
Middle Name:KAE
Last Name:HALGRIMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 ROBERTS ST N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4716
Mailing Address - Country:US
Mailing Address - Phone:701-404-9180
Mailing Address - Fax:701-936-6621
Practice Address - Street 1:305 ROBERTS ST N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4716
Practice Address - Country:US
Practice Address - Phone:701-404-9180
Practice Address - Fax:701-936-6621
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator