Provider Demographics
NPI:1811231905
Name:MCCRARY, NICOLE ASHLEY (PA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ASHLEY
Last Name:MCCRARY
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Gender:F
Credentials:PA
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Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:SUITE 330 LANKENAU MOB WEST
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-645-9093
Mailing Address - Fax:610-645-9476
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:SUITE 330 LANKENAU MOB WEST
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-645-9093
Practice Address - Fax:610-645-9476
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2015-10-21
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Provider Licenses
StateLicense IDTaxonomies
PAMA055890363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical