Provider Demographics
NPI:1073681672
Name:CREHAN, PAULA M (FNP)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:M
Last Name:CREHAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:
Practice Address - Street 1:501 NEW KARNER RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3882
Practice Address - Country:US
Practice Address - Phone:518-452-1337
Practice Address - Fax:517-724-6660
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331344363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY113661OtherGHI HMO
NY4151599OtherMVP
NY000493818003OtherBSNENY
NY01803814Medicaid
NY070425000034OtherFIDELIS
NY201113OtherSENIOR WHOLE HEALTH
NY000493818003OtherBSNENY
NY070425000034OtherFIDELIS