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Individual
CHARLES J CREVELING
Active
Individual
CHARLES J CREVELING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10001183
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0171808
LABOR AND INDUSTRIES#
WA
05
—
8368086
—
WA
01
—
CR2541
BLUE SHIELD #
WA
01
—
US0863643
AETNA SPECIALIST PIN
WA
Enumeration date
01/30/2007
Last updated
04/09/2008
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