Healthcare Provider Details

I. General information

NPI: 1366008922
Provider Name (Legal Business Name): CRYSTAL NORTON APRN-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2019
Last Update Date: 05/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 N STATE ST
OREM UT
84057-2025
US

IV. Provider business mailing address

1129 N 400 W
AMERICAN FORK UT
84003-1139
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-8255
  • Fax:
Mailing address:
  • Phone: 801-857-6795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6115251-4408
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number6115251-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: