Healthcare Provider Details

I. General information

NPI: 1225136559
Provider Name (Legal Business Name): CRYSTAL J BRANDT R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 S KIPLING ST
LAKEWOOD CO
80226-1086
US

IV. Provider business mailing address

23 BRANDT LN
EVERGREEN CO
80439-9699
US

V. Phone/Fax

Practice location:
  • Phone: 303-239-7044
  • Fax:
Mailing address:
  • Phone: 303-670-8819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number76606
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: