Provider Demographics
NPI:1063236149
Name:WILLIAMS, KRYSTAL
Entity type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4985 CASCARA LN
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-2318
Mailing Address - Country:US
Mailing Address - Phone:760-505-1663
Mailing Address - Fax:
Practice Address - Street 1:4985 CASCARA LN
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2318
Practice Address - Country:US
Practice Address - Phone:760-505-1663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula