Provider Demographics
NPI:1174816623
Name:MEHREN, CRYSTAL NICOLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:NICOLE
Last Name:MEHREN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 MAIN ST
Mailing Address - Street 2:230
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3271
Mailing Address - Country:US
Mailing Address - Phone:612-326-7600
Mailing Address - Fax:612-326-7642
Practice Address - Street 1:550 MAIN ST
Practice Address - Street 2:230
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-3271
Practice Address - Country:US
Practice Address - Phone:612-326-7600
Practice Address - Fax:612-326-7642
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL 60219-4164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse