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NPI Code Detail

MEDICARE: KELLI KRISTINE COLE-VADJIC PA-C

MEDICARE: KELLI KRISTINE COLE-VADJIC PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA10005137WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891755989
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLI KRISTINE COLE-VADJIC PA-C
Provider Business Mailing Address
First Line : 1115 SE 164TH AVE
Second Line : DEPT 358
City : VANCOUVER
State : WA
Zip : 98683-9324
Country : US
Telephone Number : 360-788-8222
Fax Number : 360-788-7759
Provider Business Practice Location Address
First Line : 3301 SQUALICUM PKWY
Second Line :
City : BELLINGHAM
State : WA
Zip : 98225-1919
Country : US
Telephone Number : 360-788-8222
Fax Number : 360-788-7759
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2006
Last Update Date : 06/11/2015

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Directions to “ KELLI KRISTINE COLE-VADJIC PA-C” Practice Location

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