Provider Demographics
NPI:1467966234
Name:MILLER, CRYSTAL RAE (RN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:RAE
Last Name:MILLER
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 1:2396 S 300 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-2853
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2396 S 300 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-2853
Practice Address - Country:US
Practice Address - Phone:562-355-5276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28234055A163WX0106X
OH428488163WX0106X
OR201606965RN163WX0106X
WARN60661271163WX0106X
KS14-137347-012163WX0106X
LARN152873163WX0106X
CA95046558163WX0106X
PARN689954163WX0106X
IL41423593163WX0106X
NJ26NR17735300163WX0106X
FLRN9403347163WX0106X
AL1-158440163WX0106X
GARN247378163WX0106X
HIRN77665163WX0106X
UT5473244-3102163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health