Provider Demographics
NPI:1326727421
Name:DEMASTER, CRYSTAL CATHERINE (RN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:CATHERINE
Last Name:DEMASTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:CATHERINE
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1915 HERMAN RD
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-1232
Mailing Address - Country:US
Mailing Address - Phone:920-226-2759
Mailing Address - Fax:
Practice Address - Street 1:1915 HERMAN RD
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-1232
Practice Address - Country:US
Practice Address - Phone:920-226-2759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261530-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty