MEDICARE: CHRYSTAL CEFARATTI IDMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1003X	Independent Duty Medical Technicians

General Provider Information

NPI Number	:	1871727487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRYSTAL CEFARATTI IDMT

Provider Business Mailing Address
First Line	:	7321 BALMER ST BLDG 569
Second Line	:	75TH AMDS/SGPF
City	:	HILL AIR FORCE BASE
State	:	UT
Zip	:	84056-5012
Country	:	US
Telephone Number	:	801-777-4710
Fax Number	:

Provider Business Practice Location Address
First Line	:	7321 BALMER ST BLDG 569
Second Line	:	75TH AMDS/SGPF
City	:	HILL AIR FORCE BASE
State	:	UT
Zip	:	84056-5012
Country	:	US
Telephone Number	:	801-777-4710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2009
Last Update Date	:	05/11/2009

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