Healthcare Provider Details

I. General information

NPI: 1629129523
Provider Name (Legal Business Name): KRIS COLLETTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 MAIN ST
VANCOUVER WA
98663-2223
US

IV. Provider business mailing address

PO BOX 34584
SEATTLE WA
98124-1584
US

V. Phone/Fax

Practice location:
  • Phone: 360-696-5232
  • Fax: 360-696-5228
Mailing address:
  • Phone: 509-241-7349
  • Fax: 509-241-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberMD00039202
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBC5836032
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00039202
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: