Provider Demographics
NPI:1629316955
Name:DECOTEAU, CRYSTAL DAWN
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:DAWN
Last Name:DECOTEAU
Suffix:
Gender:F
Credentials:
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 67
Mailing Address - Street 2:
Mailing Address - City:POPLAR
Mailing Address - State:MT
Mailing Address - Zip Code:59255-0067
Mailing Address - Country:US
Mailing Address - Phone:406-768-3603
Mailing Address - Fax:
Practice Address - Street 1:550 6TH AVE NORTH
Practice Address - Street 2:
Practice Address - City:WOLF POINT
Practice Address - State:MT
Practice Address - Zip Code:59201
Practice Address - Country:US
Practice Address - Phone:406-653-1641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist