Healthcare Provider Details

I. General information

NPI: 1689362733
Provider Name (Legal Business Name): CRYSTAL L HORIUCHI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL L MORE-PAYNE, MORE RN

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT #15245; BLDG 3031
APO AP
96271
US

IV. Provider business mailing address

PSC 333 BOX 295
APO AP
96251-0003
US

V. Phone/Fax

Practice location:
  • Phone: 50-337-1411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN.RN.60137671.MS
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberRN.RN.60137671.MSL
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60137671
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: