Provider Demographics
NPI:1770252173
Name:KOMP, CRYSTAL LEE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LEE
Last Name:KOMP
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N8150 AMUNDSON COULEE RD
Mailing Address - Street 2:
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636
Mailing Address - Country:US
Mailing Address - Phone:717-343-8744
Mailing Address - Fax:
Practice Address - Street 1:N8150 AMUNDSON COULEE RD
Practice Address - Street 2:
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636
Practice Address - Country:US
Practice Address - Phone:717-343-8744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CNM07255367A00000X
MN483367A00000X
WI149023-32367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife