Healthcare Provider Details

I. General information

NPI: 1952992653
Provider Name (Legal Business Name): CRYSTAL MARIE DYKMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 N GREENFIELD RD
GILBERT AZ
85234-8532
US

IV. Provider business mailing address

1535 N GREENFIELD RD
GILBERT AZ
85234-8532
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-2022
  • Fax: 480-813-9010
Mailing address:
  • Phone: 480-892-2022
  • Fax: 480-813-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN137429
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: