Provider Demographics
NPI:1346753589
Name:BOYD, CRYSTAL LYNN (RN)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:LYNN
Last Name:BOYD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:CRYSTAL
Other - Middle Name:LYNN
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1501 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2461
Mailing Address - Country:US
Mailing Address - Phone:262-548-7986
Mailing Address - Fax:262-896-8046
Practice Address - Street 1:1501 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-2461
Practice Address - Country:US
Practice Address - Phone:262-548-7986
Practice Address - Fax:262-896-8046
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI90402163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI396005756Medicaid