Provider Demographics
NPI:1194271262
Name:CRONKRITE, SELIN (MPH, MSHS, PA-C)
Entity type:Individual
Prefix:
First Name:SELIN
Middle Name:
Last Name:CRONKRITE
Suffix:
Gender:F
Credentials:MPH, MSHS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 NW DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-5506
Mailing Address - Country:US
Mailing Address - Phone:503-215-9500
Mailing Address - Fax:503-215-9525
Practice Address - Street 1:440 NW DIVISION ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5506
Practice Address - Country:US
Practice Address - Phone:503-215-9500
Practice Address - Fax:503-215-9525
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA179522363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant