Provider Demographics
NPI:1912342932
Name:THOMPSON, CRYSTAL ROSE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:ROSE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:ROSE
Other - Last Name:POPPKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1940 DENVER WEST DR APT 524
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3160
Mailing Address - Country:US
Mailing Address - Phone:208-890-4686
Mailing Address - Fax:
Practice Address - Street 1:3333 S WADSWORTH BLVD UNIT D100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-5117
Practice Address - Country:US
Practice Address - Phone:303-205-1090
Practice Address - Fax:303-205-5534
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0990730367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56674376Medicaid