Healthcare Provider Details

I. General information

NPI: 1851053268
Provider Name (Legal Business Name): CRYSTAL AUJHAE HUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CRYSTAL AUJHAE HRESTAK

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E MARKET ST
WILLIAMSTOWN PA
17098-1510
US

IV. Provider business mailing address

4203 UNION DEPOSIT RD # 1050
HARRISBURG PA
17111-2802
US

V. Phone/Fax

Practice location:
  • Phone: 717-500-1192
  • Fax:
Mailing address:
  • Phone: 717-500-1192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: