Basic Information
| Provider Information | |||||||||
| NPI: | 1952414872 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRANK | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | ERIN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10240 PARK MEADOWS DR | ||||||||
| Address2: | |||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801245425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033384545 | ||||||||
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| Practice Location | |||||||||
| Address1: | 525 BOB PETERS GRV STE 202 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809094533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193656568 | ||||||||
| FaxNumber: | 7193656317 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 08/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 3975 | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | 3477 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | PA.0003975 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 025016 | 01 | CO | KAISER COMMERCIAL NUMBER | OTHER | 307093 | 05 | AZ | MEDICAID | P00623803 | 01 | AZ | RAILROAD MEDICARE | OTHER | 49035045 | 05 | CO | MEDICAID |