Provider Demographics
NPI:1386398790
Name:MCCRACKEN, ANNA CHRISTINE (CNM)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:CHRISTINE
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11311 BRIDGEPORT WAY SW STE 214
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3051
Mailing Address - Country:US
Mailing Address - Phone:253-985-2920
Mailing Address - Fax:253-985-6812
Practice Address - Street 1:11311 BRIDGEPORT WAY SW STE 214
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3051
Practice Address - Country:US
Practice Address - Phone:253-985-2920
Practice Address - Fax:253-985-6812
Is Sole Proprietor?:No
Enumeration Date:2022-02-05
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31039367A00000X
WAAP61474352367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2272477Medicaid