Provider Demographics
NPI:1629187547
Name:CRISON, GRETEL K (DPM)
Entity Type:Individual
Prefix:
First Name:GRETEL
Middle Name:K
Last Name:CRISON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:GRETEL
Other - Middle Name:K
Other - Last Name:GAERTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:8734 S PIPER LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-1426
Mailing Address - Country:US
Mailing Address - Phone:801-839-8337
Mailing Address - Fax:844-477-2511
Practice Address - Street 1:3024 WEST 300 NORTH, STE C
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:UT
Practice Address - Zip Code:84015
Practice Address - Country:US
Practice Address - Phone:385-393-8224
Practice Address - Fax:385-393-8225
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT295448-0501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U59211Medicare UPIN