Provider Demographics
NPI:1023432028
Name:OGLE, CRYSTAL (LM, CPM)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:OGLE
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:WA
Mailing Address - Zip Code:98236
Mailing Address - Country:US
Mailing Address - Phone:425-971-3731
Mailing Address - Fax:
Practice Address - Street 1:7149 MAXWELTON RD.
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236
Practice Address - Country:US
Practice Address - Phone:425-971-3731
Practice Address - Fax:855-272-1650
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
WAMW60452672176B00000X
14020009176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife