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General NPI Number Information
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NPI Number | 1316380702
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Entity Type | Individual
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Provider Name | CRYSTAL LEIGH MYATT RN
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Gender | Female
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Dates
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Enumeration Date | 04/16/2013
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | WEED ARMY COMMUNITY HOSPITAL, BLDG 166 3RD AND INNER LOOP RD, BLDG 166, RM 414
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City | FORT IRWIN
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State | CA
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Zip | 92310-5109
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Country | US
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Telephone | 760-380-5388
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Fax | 760-380-2122
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Provider Business Mailing Address
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Address Line | WEED ARMY COMMUNITY HOSPITAL, BLDG 166 3RD AND INNER LOOP RD, BLDG 166, RM 414
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City | FORT IRWIN
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State | CA
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Zip | 92310-5109
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Country | US
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Telephone | 760-380-5388
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Fax | 760-380-2122
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1107036
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License Number State | KY
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