Healthcare Provider Details

I. General information

NPI: 1629187547
Provider Name (Legal Business Name): GRETEL K CRISON DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRETEL K GAERTNER DPM

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 WEST 300 NORTH, STE C
WEST POINT UT
84015
US

IV. Provider business mailing address

8734 S PIPER LN
SANDY UT
84093-1426
US

V. Phone/Fax

Practice location:
  • Phone: 385-393-8224
  • Fax: 385-393-8225
Mailing address:
  • Phone: 801-839-8337
  • Fax: 844-477-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number295448-0501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: