Provider Demographics
NPI:1922204783
Name:MICHALAK, CRYSTAL (RN)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:
Last Name:MICHALAK
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 1:7511 S 73RD ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9755
Mailing Address - Country:US
Mailing Address - Phone:414-614-0257
Mailing Address - Fax:
Practice Address - Street 1:7511 S 73RD ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9755
Practice Address - Country:US
Practice Address - Phone:414-614-0257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35031500Medicaid