Provider Demographics
NPI:1215208848
Name:KAFER, CRYSTAL DESIREE (CRNA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DESIREE
Last Name:KAFER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:DESIREE
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5815 NUEVO LEON ST
Mailing Address - Street 2:UNIT 4
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3699
Mailing Address - Country:US
Mailing Address - Phone:813-476-2396
Mailing Address - Fax:
Practice Address - Street 1:5815 NUEVO LEON ST
Practice Address - Street 2:UNIT 4
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-3699
Practice Address - Country:US
Practice Address - Phone:813-476-2396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9268631367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered