Provider Demographics
NPI:1467076539
Name:CRANDALL, ANDREA TAYLOR (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:TAYLOR
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9637 SW 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5164
Mailing Address - Country:US
Mailing Address - Phone:503-754-0227
Mailing Address - Fax:
Practice Address - Street 1:19250 SW 65TH AVE STE 365
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7747
Practice Address - Country:US
Practice Address - Phone:503-692-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant