Healthcare Provider Details

I. General information

NPI: 1114122280
Provider Name (Legal Business Name): CRYSTAL ORIEL LARRABEE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 EXEMPLA CIR
LAFAYETTE CO
80026-3370
US

IV. Provider business mailing address

1212 S EMERY ST UNIT B
LONGMONT CO
80501-8944
US

V. Phone/Fax

Practice location:
  • Phone: 720-536-7457
  • Fax:
Mailing address:
  • Phone: 720-684-6171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number184666
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: