Provider Demographics
NPI:1417523218
Name:VIGDAL, CRYSTAL (DNAP, RN, CRNA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:VIGDAL
Suffix:
Gender:F
Credentials:DNAP, RN, CRNA
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:KNUTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:705 S TAMA ST
Mailing Address - Street 2:
Mailing Address - City:ROCK RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:51246-1916
Mailing Address - Country:US
Mailing Address - Phone:515-979-0473
Mailing Address - Fax:
Practice Address - Street 1:2720 STONE PARK BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3734
Practice Address - Country:US
Practice Address - Phone:712-279-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD163641367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered