Healthcare Provider Details

I. General information

NPI: 1215873518
Provider Name (Legal Business Name): CRYSTAL MEINZER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 PFLAUM RD
MADISON WI
53716-2167
US

IV. Provider business mailing address

1325 CONDE ST
JANESVILLE WI
53546-5879
US

V. Phone/Fax

Practice location:
  • Phone: 608-264-3662
  • Fax:
Mailing address:
  • Phone: 608-333-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number1109544
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: