Provider Demographics
NPI:1962655506
Name:MCCRACKIN, JULIE (CRNA, MS)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:MCCRACKIN
Suffix:
Gender:F
Credentials:CRNA, MS
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:MARION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5777 E MAYO BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-4502
Mailing Address - Country:US
Mailing Address - Phone:480-342-5578
Mailing Address - Fax:
Practice Address - Street 1:4331 E BASELINE RD STE B105-625
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2961
Practice Address - Country:US
Practice Address - Phone:480-981-0216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN117432367500000X
MN1927367500000X
AZCRNA0600367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered