Provider Demographics
NPI:1992578280
Name:MAIERS, CHRYSTA ELLIS
Entity type:Individual
Prefix:
First Name:CHRYSTA
Middle Name:ELLIS
Last Name:MAIERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRYSTA
Other - Middle Name:LEE
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:3404 COYOTE LN
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-3832
Mailing Address - Country:US
Mailing Address - Phone:760-855-7440
Mailing Address - Fax:
Practice Address - Street 1:3404 COYOTE LN
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-3832
Practice Address - Country:US
Practice Address - Phone:760-855-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA731841163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse