Provider Demographics
NPI:1679368534
Name:JOHNSON, CRYSTAL W (RN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:W
Last Name:JOHNSON
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1092 E 300 S
Mailing Address - Street 2:
Mailing Address - City:SANTAQUIN
Mailing Address - State:UT
Mailing Address - Zip Code:84655-5605
Mailing Address - Country:US
Mailing Address - Phone:435-660-9721
Mailing Address - Fax:
Practice Address - Street 1:1092 E 300 S
Practice Address - Street 2:
Practice Address - City:SANTAQUIN
Practice Address - State:UT
Practice Address - Zip Code:84655-5605
Practice Address - Country:US
Practice Address - Phone:435-660-9721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5778123-3102163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care