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General NPI Number Information
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NPI Number | 1679898100
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Entity Type | Individual
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Provider Name | KRISTI LYNN COLONNA PA
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Gender | Female
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Dates
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Enumeration Date | 03/27/2010
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Last Update Date | 03/27/2010
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Provider Practice Location Address
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Address Line | 1311 E THOMAS RD
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City | PHOENIX
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State | AZ
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Zip | 85014-5707
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Country | US
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Telephone | 602-322-1315
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Fax |
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Provider Business Mailing Address
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Address Line | 8010 S 18TH PL
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City | PHOENIX
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State | AZ
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Zip | 85042-6806
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2672
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License Number State | AZ
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