Provider Demographics
NPI:1194494443
Name:KATSCHMAN-COLIPANO, PRELON K (PA-C)
Entity type:Individual
Prefix:
First Name:PRELON
Middle Name:K
Last Name:KATSCHMAN-COLIPANO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:PRELON
Other - Middle Name:K
Other - Last Name:KATSCHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:
Practice Address - Street 1:550 17TH AVE STE 680
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5795
Practice Address - Country:US
Practice Address - Phone:206-215-4545
Practice Address - Fax:206-215-4550
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61353021363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant