Provider Demographics
NPI:1427665272
Name:MCCRACKEN, STACEY LYNN (RCP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:RCP
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LYNN
Other - Last Name:MCCRACKEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RCP RESPIRATORY THER
Mailing Address - Street 1:2301 CEDLEY ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-3117
Mailing Address - Country:US
Mailing Address - Phone:667-967-0980
Mailing Address - Fax:
Practice Address - Street 1:2301 CEDLEY ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-3117
Practice Address - Country:US
Practice Address - Phone:667-967-0980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLO1324227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLO1324OtherBPQA