Provider Demographics
NPI:1811034507
Name:MCCREADIE, EMMAJEAN (NP)
Entity Type:Individual
Prefix:
First Name:EMMAJEAN
Middle Name:
Last Name:MCCREADIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 227
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3506
Mailing Address - Country:US
Mailing Address - Phone:213-413-2700
Mailing Address - Fax:213-413-6722
Practice Address - Street 1:2005 WILSHIRE BLVD
Practice Address - Street 2:LOS ANGELES
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3503
Practice Address - Country:US
Practice Address - Phone:213-413-2700
Practice Address - Fax:213-413-6722
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN209322363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP2136OtherNP LICENSE
CARN209322Medicaid