Provider Demographics
NPI:1215203617
Name:BRACKEN, MICHELE I (CRNP)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:I
Last Name:BRACKEN
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 1:4384 CRISFIELD HWY
Mailing Address - Street 2:
Mailing Address - City:CRISFIELD
Mailing Address - State:MD
Mailing Address - Zip Code:21817-2550
Mailing Address - Country:US
Mailing Address - Phone:443-493-0062
Mailing Address - Fax:
Practice Address - Street 1:4384 CRISFIELD HWY
Practice Address - Street 2:
Practice Address - City:CRISFIELD
Practice Address - State:MD
Practice Address - Zip Code:21817-2550
Practice Address - Country:US
Practice Address - Phone:443-493-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR091871363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology