Healthcare Provider Details

I. General information

NPI: 1386398790
Provider Name (Legal Business Name): ANNA CHRISTINE MCCRACKEN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2022
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11311 BRIDGEPORT WAY SW STE 214
LAKEWOOD WA
98499-3051
US

IV. Provider business mailing address

11311 BRIDGEPORT WAY SW STE 214
LAKEWOOD WA
98499-3051
US

V. Phone/Fax

Practice location:
  • Phone: 253-985-2920
  • Fax: 253-985-6812
Mailing address:
  • Phone: 253-985-2920
  • Fax: 253-985-6812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number31039
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP61474352
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: