Healthcare Provider Details

I. General information

NPI: 1003284290
Provider Name (Legal Business Name): CRYSTAL-ANN SPANN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL-ANN B. SPANN

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 03/16/2025
Certification Date: 03/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
TACOMA WA
98431-2858
US

IV. Provider business mailing address

9040 REID ST
JOINT BASE LEWIS MCCHORD WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-966-3677
  • Fax:
Mailing address:
  • Phone: 253-968-4305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN60089490
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN60089490
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number60089490
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: