1710021894 NPI number — ELIZABETH A MCCRANK PA-C

Table of content: ELIZABETH A MCCRANK PA-C (NPI 1710021894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710021894 NPI number — ELIZABETH A MCCRANK PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCRANK
Provider First Name:
ELIZABETH
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710021894
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 LITTLE MOUNTAIN LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98274-8752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-428-2622
Provider Business Mailing Address Fax Number:
360-428-3941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 LITTLE MOUNTAIN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-542-1396
Provider Business Practice Location Address Fax Number:
360-428-3941
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA10004099 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8321499 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0144974 . This is a "LABOR & INDUSTRIES (REG)" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com