Provider Demographics
NPI:1689974305
Name:CZAPLICKI, CRYSTAL E (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:E
Last Name:CZAPLICKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:CRYSTAL
Other - Middle Name:E
Other - Last Name:SEALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3600 LIND AVE SW
Mailing Address - Street 2:SUITE 100 ATTN CREDENTIALING
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4970
Mailing Address - Country:US
Mailing Address - Phone:425-690-2715
Mailing Address - Fax:
Practice Address - Street 1:26458 MAPLE VALLEY BLACK DIAMOND RD SE
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8350
Practice Address - Country:US
Practice Address - Phone:425-690-3465
Practice Address - Fax:425-690-9460
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60188798363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2010027Medicaid