Provider Demographics
NPI:1639710650
Name:MCCRACKEN, JUSTINE (CRNP)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 LITITZ PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2427
Mailing Address - Country:US
Mailing Address - Phone:717-314-0924
Mailing Address - Fax:
Practice Address - Street 1:700 LANCASTER ROAD
Practice Address - Street 2:
Practice Address - City:MANHEIM
Practice Address - State:PA
Practice Address - Zip Code:17545-2314
Practice Address - Country:US
Practice Address - Phone:717-314-0924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020644363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily