Healthcare Provider Details

I. General information

NPI: 1669033098
Provider Name (Legal Business Name): MRS. CRYSTAL BELLE PHIPPS BLOOMFELDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W MARINE VIEW DR
EVERETT WA
98207-5000
US

IV. Provider business mailing address

1002 N 19TH AVE
KELSO WA
98626-5126
US

V. Phone/Fax

Practice location:
  • Phone: 360-355-7658
  • Fax:
Mailing address:
  • Phone: 360-355-7658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: