Provider Demographics
NPI:1841590502
Name:KRULICH, BARBARA ANN (PA)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ANN
Last Name:KRULICH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:ANN
Other - Last Name:MAKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2700 EVERGREEN PARKWAY NW
Mailing Address - Street 2:SEMINAR I 2126
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98505
Mailing Address - Country:US
Mailing Address - Phone:360-867-6200
Mailing Address - Fax:360-867-6787
Practice Address - Street 1:2700 EVERGREEN PARKWAY NW
Practice Address - Street 2:SEMINAR I 2100
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98505
Practice Address - Country:US
Practice Address - Phone:360-867-6200
Practice Address - Fax:360-867-6787
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
595999Medicare UPIN