Provider Demographics
NPI:1104916923
Name:ANDRIJIW, COLLEEN INES (PA-C)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:INES
Last Name:ANDRIJIW
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:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547-0069
Mailing Address - Country:US
Mailing Address - Phone:970-301-0130
Mailing Address - Fax:970-673-4747
Practice Address - Street 1:6801 W 20TH ST UNIT 208
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634
Practice Address - Country:US
Practice Address - Phone:970-673-1155
Practice Address - Fax:970-673-4747
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103563363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant