Provider Demographics
NPI:1720735137
Name:HUENE, CRYSTAL DAWN (BSN, RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:DAWN
Last Name:HUENE
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 GREEN WING RD
Mailing Address - Street 2:
Mailing Address - City:AMBOY
Mailing Address - State:IL
Mailing Address - Zip Code:61310-9427
Mailing Address - Country:US
Mailing Address - Phone:608-514-2828
Mailing Address - Fax:
Practice Address - Street 1:775 GREEN WING RD
Practice Address - Street 2:
Practice Address - City:AMBOY
Practice Address - State:IL
Practice Address - Zip Code:61310-9427
Practice Address - Country:US
Practice Address - Phone:608-514-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-05
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041327739163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant