Provider Demographics
NPI:1326505918
Name:ALDERSON, CRYSTAL KAYE (LPN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:KAYE
Last Name:ALDERSON
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 1:544 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-5014
Mailing Address - Country:US
Mailing Address - Phone:920-203-0683
Mailing Address - Fax:
Practice Address - Street 1:544 GRAND ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-5014
Practice Address - Country:US
Practice Address - Phone:920-203-0683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI315474164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse