Healthcare Provider Details

I. General information

NPI: 1730487968
Provider Name (Legal Business Name): MELISSA MCCRACKEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 AIRPORT HEIGHTS DR SUITE 278
ANCHORAGE AK
99508-2965
US

IV. Provider business mailing address

1200 AIRPORT HEIGHTS DR SUITE 278
ANCHORAGE AK
99508-2965
US

V. Phone/Fax

Practice location:
  • Phone: 907-929-4263
  • Fax:
Mailing address:
  • Phone: 907-929-4263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number30156
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: