Provider Demographics
NPI:1194308056
Name:STEIN, CRYSTAL
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:STEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:ARMENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 N LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:IA
Mailing Address - Zip Code:52229-9523
Mailing Address - Country:US
Mailing Address - Phone:319-560-7610
Mailing Address - Fax:
Practice Address - Street 1:203 N LOCUST AVE
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:IA
Practice Address - Zip Code:52229-9523
Practice Address - Country:US
Practice Address - Phone:319-560-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA899RR2616Medicaid