Provider Demographics
NPI:1740746452
Name:CHRETIEN, DANA (PA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:CHRETIEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9701 E ILIFF AVE APT 2327
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4282
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 E WASHINGTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8161
Practice Address - Country:US
Practice Address - Phone:707-465-6925
Practice Address - Fax:707-465-6070
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COP.A.0005699363A00000X
CA62097363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant