# CRYSTAL TWYNHAM MD PLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962707398
- **Authorized official:** DR. CRYSTAL ULANI TWYNHAM MD (OWNER)
- **Authorized official phone:** (931) 237-2265

## Contact information

- **Practice address:** 15552 68TH PL N, MAPLE GROVE, MN 55311-3291
- **Practice address phone:** (931) 237-2265
- **Practice address fax:** (612) 594-8998
- **Mailing address:** 15552 68TH PL N, MAPLE GROVE, MN 55311-3291
- **Mailing address phone:** (931) 237-2265
- **Mailing address fax:** (612) 594-8998

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 39691 | MN | Yes |

## Other

- **Enumeration date:** 01/15/2011
- **Last updated:** 06/01/2015