Provider Demographics
NPI:1922556398
Name:PADILLA, CRYSTAL L (RN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:L
Last Name:PADILLA
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 HELEN ST.
Mailing Address - Street 2:
Mailing Address - City:SAUK CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53583-1101
Mailing Address - Country:US
Mailing Address - Phone:608-643-3351
Mailing Address - Fax:608-643-3621
Practice Address - Street 1:112 HELEN ST.
Practice Address - Street 2:
Practice Address - City:SAUK CITY
Practice Address - State:WI
Practice Address - Zip Code:53583-1101
Practice Address - Country:US
Practice Address - Phone:608-643-3351
Practice Address - Fax:608-643-3621
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI176524-30163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator