Provider Demographics
NPI:1972754075
Name:HARN, CRYSTAL A (APNP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:A
Last Name:HARN
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:A
Other - Last Name:KARABA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:2401 PLOVER ROAD
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-3916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 ILLINOIS AVENUE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-3114
Practice Address - Country:US
Practice Address - Phone:715-346-5170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3513363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3513OtherWI STATE APNP LICENSE