Provider Demographics
NPI:1508915679
Name:CRAWFORD, NIKKI R (PAC)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:R
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:R
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1100 OLIVE WAY MSC M4-PA
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1873
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:33501 1ST WAY S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6208
Practice Address - Country:US
Practice Address - Phone:253-838-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004560363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00088504OtherRAILROAD MEDICARE #
WA0039594OtherLABOR AND INDUSTRIES #
WA8388159Medicaid
WAUS7831554OtherAETNA SPECIALIST PIN
WA7374WIOtherBLUE SHIELD #
WAUS7831554OtherAETNA SPECIALIST PIN
Q06561Medicare UPIN