Healthcare Provider Details

I. General information

NPI: 1912885872
Provider Name (Legal Business Name): CRYSTAL RENEE AUSTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8276 CLOVERDALE WAY
INDIANAPOLIS IN
46256-8109
US

IV. Provider business mailing address

8276 CLOVERDALE WAY
INDIANAPOLIS IN
46256-8109
US

V. Phone/Fax

Practice location:
  • Phone: 317-250-4386
  • Fax:
Mailing address:
  • Phone: 317-250-4386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: