MEDICARE: EMMAJEAN MCCREADIE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	RN209322	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NP2136	OTHER	CA	NP LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811034507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMAJEAN MCCREADIE NP

Provider Business Mailing Address
First Line	:	2007 WILSHIRE BLVD
Second Line	:	SUITE 227
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3506
Country	:	US
Telephone Number	:	213-413-2700
Fax Number	:	213-413-6722

Provider Business Practice Location Address
First Line	:	2005 WILSHIRE BLVD
Second Line	:	LOS ANGELES
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3503
Country	:	US
Telephone Number	:	213-413-2700
Fax Number	:	213-413-6722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/09/2007

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