Healthcare Provider Details

I. General information

NPI: 1265627871
Provider Name (Legal Business Name): REBECCA LYNN MCCRACKEN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 BROADWAY STE 1019
NEW YORK NY
10003-6803
US

IV. Provider business mailing address

769 BROADWAY STE 1019
NEW YORK NY
10003-6803
US

V. Phone/Fax

Practice location:
  • Phone: 201-564-5109
  • Fax:
Mailing address:
  • Phone: 201-564-5109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF001289-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: