Provider Demographics
NPI:1710267737
Name:NIEDERMEYER, CRYSTAL ARNOLD (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:ARNOLD
Last Name:NIEDERMEYER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2693 WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3856
Mailing Address - Country:US
Mailing Address - Phone:541-326-8132
Mailing Address - Fax:
Practice Address - Street 1:312 OAK ST
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2399
Practice Address - Country:US
Practice Address - Phone:541-326-8132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12254171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor