Provider Demographics
NPI:1952414872
Name:CRANK, REBECCA ERIN (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ERIN
Last Name:CRANK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10240 PARK MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5425
Mailing Address - Country:US
Mailing Address - Phone:303-338-4545
Mailing Address - Fax:
Practice Address - Street 1:525 BOB PETERS GRV STE 202
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-4533
Practice Address - Country:US
Practice Address - Phone:719-365-6568
Practice Address - Fax:719-365-6317
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3975363AM0700X
AZ3477363AM0700X
COPA.0003975363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO025016OtherKAISER COMMERCIAL NUMBER
AZ307093Medicaid
AZP00623803OtherRAILROAD MEDICARE
CO49035045Medicaid
CO025016OtherKAISER COMMERCIAL NUMBER
AZ307093Medicaid