Healthcare Provider Details

I. General information

NPI: 1740746452
Provider Name (Legal Business Name): DANA CHRETIEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E WASHINGTON BLVD STE 100
CRESCENT CITY CA
95531-8161
US

IV. Provider business mailing address

9701 E ILIFF AVE APT 2327
DENVER CO
80231-4282
US

V. Phone/Fax

Practice location:
  • Phone: 707-465-6925
  • Fax: 707-465-6070
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberP.A.0005699
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number62097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: