Provider Demographics
NPI:1750045274
Name:SMITH, CRYSTAL RAE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:RAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:RAE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:148 HOOD ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-3642
Mailing Address - Country:US
Mailing Address - Phone:503-656-4035
Mailing Address - Fax:503-656-1089
Practice Address - Street 1:148 HOOD ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-3642
Practice Address - Country:US
Practice Address - Phone:503-656-4035
Practice Address - Fax:503-656-1089
Is Sole Proprietor?:No
Enumeration Date:2021-10-30
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201604415RN163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice