Provider Demographics
NPI:1063656452
Name:MALM, CRYSTAL ANN (CST)
Entity type:Individual
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First Name:CRYSTAL
Middle Name:ANN
Last Name:MALM
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Gender:F
Credentials:CST
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Mailing Address - Street 1:701 25TH AVE S
Mailing Address - Street 2:SUITE 505
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1513
Mailing Address - Country:US
Mailing Address - Phone:612-455-2008
Mailing Address - Fax:612-455-2009
Practice Address - Street 1:6545 FRANCE AVE S
Practice Address - Street 2:SUITE 160
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2131
Practice Address - Country:US
Practice Address - Phone:952-835-0750
Practice Address - Fax:952-835-0662
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist