Healthcare Provider Details

I. General information

NPI: 1861715310
Provider Name (Legal Business Name): CHELSEA LUNDSTROM CROSBY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA LUNDSTROM WOODS PA-C

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16233 SYLVESTER RD SW STE 260
BURIEN WA
98166-3044
US

IV. Provider business mailing address

16233 SYLVESTER RD SW STE 260
BURIEN WA
98166-3044
US

V. Phone/Fax

Practice location:
  • Phone: 206-835-7400
  • Fax: 253-426-6344
Mailing address:
  • Phone: 206-835-7400
  • Fax: 253-426-6344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60135343
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.60135343
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: