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General NPI Number Information
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NPI Number | 1578065348
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Entity Type | Individual
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Provider Name | CRYSTALYN MORTON CPNP
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Gender | Female
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 05/03/2021
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Provider Practice Location Address
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Address Line | 2500 COMO AVE MAIL STOP 31100A
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City | SAINT PAUL
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State | MN
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Zip | 55108-1460
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Country | US
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Telephone | 651-641-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 8170 33RD AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55425-4516
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Country | US
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Telephone |
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5783
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 225621-30
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R1656822
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License Number State | MN
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