Provider Demographics
NPI:1851516587
Name:MCCRACKEN, MELINDA SUE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:MELINDA
Middle Name:SUE
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 4 BOX 62
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:WV
Mailing Address - Zip Code:26033-9732
Mailing Address - Country:US
Mailing Address - Phone:304-686-3874
Mailing Address - Fax:
Practice Address - Street 1:2250 HICKORY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1047
Practice Address - Country:US
Practice Address - Phone:800-355-1225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN273212164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse