MEDICARE: CRYSTAL ROMAY R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	130327	MO

General Provider Information

NPI Number	:	1063445039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL ROMAY R.N.

Provider Business Mailing Address
First Line	:	1110 N FREMONT AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65802-3511
Country	:	US
Telephone Number	:	417-865-9090
Fax Number	:	417-864-3226

Provider Business Practice Location Address
First Line	:	1110 N FREMONT AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65802-3511
Country	:	US
Telephone Number	:	417-865-9090
Fax Number	:	417-864-3226

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/08/2007

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