Provider Demographics
NPI:1164503314
Name:MCCOLLUM, BRYNA DUNAWAY (PA-C)
Entity type:Individual
Prefix:
First Name:BRYNA
Middle Name:DUNAWAY
Last Name:MCCOLLUM
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 1:13231 SE 36TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-7321
Mailing Address - Country:US
Mailing Address - Phone:425-957-9000
Mailing Address - Fax:
Practice Address - Street 1:13231 SE 36TH ST STE 110
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-7321
Practice Address - Country:US
Practice Address - Phone:425-957-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004929363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPENDINGMedicare UPIN