Provider Demographics
NPI:1396293726
Name:MUGFORD, CRYSTAL (RN)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:MUGFORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 23RD ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4363
Mailing Address - Country:US
Mailing Address - Phone:970-945-1234
Mailing Address - Fax:
Practice Address - Street 1:401 23RD ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4363
Practice Address - Country:US
Practice Address - Phone:970-945-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9416982-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse