Provider Demographics
NPI:1346926946
Name:STUWE, KRYSTAL GAYLE (RN)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:GAYLE
Last Name:STUWE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:HOVEN
Mailing Address - State:SD
Mailing Address - Zip Code:57450-0328
Mailing Address - Country:US
Mailing Address - Phone:605-228-5406
Mailing Address - Fax:
Practice Address - Street 1:401 O'GORMAN STREET
Practice Address - Street 2:
Practice Address - City:HOVEN
Practice Address - State:SD
Practice Address - Zip Code:57450
Practice Address - Country:US
Practice Address - Phone:605-948-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR032583163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn