Provider Demographics
NPI:1841548161
Name:MEYER, CRYSTAL ELIZABETH (ARNP)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:ELIZABETH
Last Name:MEYER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 ENTERPRISE AVE
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360
Mailing Address - Country:US
Mailing Address - Phone:712-336-2728
Mailing Address - Fax:712-336-2842
Practice Address - Street 1:2704 ENTERPRISE AVE
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360
Practice Address - Country:US
Practice Address - Phone:712-336-2728
Practice Address - Fax:712-336-2842
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-118055363L00000X
IAA118055363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1194186833Medicaid