Provider Demographics
NPI:1689144248
Name:HADLEY, CRYSTAL (RN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:HADLEY
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 1:477 23RD STREET
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401
Mailing Address - Country:US
Mailing Address - Phone:801-399-7236
Mailing Address - Fax:801-399-7256
Practice Address - Street 1:477 23RD STREET
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401
Practice Address - Country:US
Practice Address - Phone:801-399-7236
Practice Address - Fax:801-399-7256
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6604727-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000094010Medicaid
UT529949454073Medicaid
UT998877666002Medicaid
UT876000308011Medicaid