Healthcare Provider Details

I. General information

NPI: 1588037097
Provider Name (Legal Business Name): KRYSTAL CLEAVER CLD, HCHD, CBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10164 RIVERSTONE DR
PARKER CO
80134-9164
US

IV. Provider business mailing address

10164 RIVERSTONE DR
PARKER CO
80134-9164
US

V. Phone/Fax

Practice location:
  • Phone: 720-675-8343
  • Fax:
Mailing address:
  • Phone: 720-675-8343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: