Healthcare Provider Details

I. General information

NPI: 1063195394
Provider Name (Legal Business Name): CRISTA BRACKLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 ALPHA DR
PITTSBURGH PA
15238-2832
US

IV. Provider business mailing address

2366 GOLDEN MILE HWY PMB 253
PITTSBURGH PA
15239
US

V. Phone/Fax

Practice location:
  • Phone: 412-820-2050
  • Fax:
Mailing address:
  • Phone: 412-897-5782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN582041
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: