Healthcare Provider Details

I. General information

NPI: 1891365235
Provider Name (Legal Business Name): CRYSTAL LYNN IDDINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3624 FLETCHER CIR
AMES IA
50010-4165
US

IV. Provider business mailing address

3624 FLETCHER CIR
AMES IA
50010-4165
US

V. Phone/Fax

Practice location:
  • Phone: 832-226-9248
  • Fax:
Mailing address:
  • Phone: 832-226-9248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberB164269
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: