Healthcare Provider Details

I. General information

NPI: 1154648251
Provider Name (Legal Business Name): CRYSTAL ANN CHAVERS RDMS,RVT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CRYSTAL ANN MILLS RDMS,RVT

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W LEOTA ST
NORTH PLATTE NE
69101-6525
US

IV. Provider business mailing address

4422 SE BEAVER LN
STUART FL
34997-5528
US

V. Phone/Fax

Practice location:
  • Phone: 308-696-8000
  • Fax:
Mailing address:
  • Phone: 561-389-4314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number120173
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: