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General NPI Number Information
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NPI Number | 1750568119
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Entity Type | Individual
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Provider Name | CRYSTAL COLLERAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 08/19/2021
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Provider Practice Location Address
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Address Line | 4033 TALBOT RD S STE 530
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City | RENTON
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State | WA
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Zip | 98055-5700
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Country | US
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Telephone | 425-690-3433
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Fax | 425-690-9433
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Provider Business Mailing Address
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Address Line | 3600 LIND AVE SW SUITE 100 ATTN CREDENTIALING
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City | RENTON
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State | WA
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Zip | 98057-4970
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Country | US
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Telephone | 425-690-2715
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA60285496
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA60285496
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | MA053315
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License Number State | PA
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