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General NPI Number Information
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NPI Number | 1629446331
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Entity Type | Individual
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Provider Name | CRYSTAL GUTTMAN APNP
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Gender | Female
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Dates
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Enumeration Date | 09/11/2015
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 3925 N GATEWAY DR
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City | APPLETON
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State | WI
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Zip | 54913-7863
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Country | US
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Telephone | 920-749-1171
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Fax |
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Provider Business Mailing Address
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Address Line | 3232 N BALLARD RD STE 200
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City | APPLETON
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State | WI
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Zip | 54911-8804
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Country | US
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Telephone | 920-749-9668
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 6637-33
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License Number State | WI
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