Healthcare Provider Details

I. General information

NPI: 1427665272
Provider Name (Legal Business Name): STACEY LYNN MCCRACKEN RCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACEY LYNN MCCRACKEN RCP RESPIRATORY THER

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 CEDLEY ST
BALTIMORE MD
21230-3117
US

IV. Provider business mailing address

2301 CEDLEY ST
BALTIMORE MD
21230-3117
US

V. Phone/Fax

Practice location:
  • Phone: 667-967-0980
  • Fax:
Mailing address:
  • Phone: 667-967-0980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberLO1324
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: