Individual
CHARLES J CREVELING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
904 7TH AVE, SEATTLE, WA 98104-1132
(206) 223-6487
Mailing address
1100 OLIVE WAY MSC M4-PA, SEATTLE, WA 98101-1873
(206) 511-5581
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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