Provider Demographics
NPI:1932823804
Name:WATERS, CRYSTAL DEE (BSN, RN-BC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DEE
Last Name:WATERS
Suffix:
Gender:F
Credentials:BSN, RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5797 W CONSERVATION DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:CO
Mailing Address - Zip Code:80504-9687
Mailing Address - Country:US
Mailing Address - Phone:720-323-7240
Mailing Address - Fax:
Practice Address - Street 1:5797 W CONSERVATION DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:CO
Practice Address - Zip Code:80504-9687
Practice Address - Country:US
Practice Address - Phone:720-323-7240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0186927163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse