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Individual

STEPHEN DANIEL KRIVAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
2200 NE NEFF RD STE 302, BEND, OR 97701-4279
(541) 706-4220
(541) 597-5819
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 568-7043

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA61073127
WA
363AS0400X
Surgical Physician Assistant
PA61073127
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1164934865
WA
Enumeration date
11/02/2017
Last updated
08/01/2024
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