Provider Demographics
NPI:1851053268
Name:HUTSON, CRYSTAL AUJHAE
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:AUJHAE
Last Name:HUTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:AUJHAE
Other - Last Name:HRESTAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4203 UNION DEPOSIT RD # 1050
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2802
Mailing Address - Country:US
Mailing Address - Phone:717-500-1192
Mailing Address - Fax:
Practice Address - Street 1:240 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17098-1510
Practice Address - Country:US
Practice Address - Phone:717-500-1192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay