Provider Demographics
NPI:1609436856
Name:CREW, TRACI N (CRNP)
Entity Type:Individual
Prefix:MISS
First Name:TRACI
Middle Name:N
Last Name:CREW
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1703 INNOVATION DR STE 2001
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-8815
Mailing Address - Country:US
Mailing Address - Phone:717-801-0765
Mailing Address - Fax:717-801-0645
Practice Address - Street 1:1703 INNOVATION DR STE 2001
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-8815
Practice Address - Country:US
Practice Address - Phone:717-801-0765
Practice Address - Fax:717-801-0645
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDF07190671207Q00000X
PASP024716363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine