Provider Demographics
NPI:1184431512
Name:MC CRACKEN, ELLE QUINN
Entity type:Individual
Prefix:
First Name:ELLE
Middle Name:QUINN
Last Name:MC CRACKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 BROCKENBRAUGH ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-3716
Mailing Address - Country:US
Mailing Address - Phone:928-499-5814
Mailing Address - Fax:
Practice Address - Street 1:1619 BROCKENBRAUGH ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-3716
Practice Address - Country:US
Practice Address - Phone:928-499-5814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA217268163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty