Provider Demographics
NPI:1891804845
Name:MCCRACKEN, MAUREEN HARRIS (APRN, BC)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:HARRIS
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3618
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20195-1618
Mailing Address - Country:US
Mailing Address - Phone:703-606-3285
Mailing Address - Fax:703-435-1961
Practice Address - Street 1:489A CARLISLE DRIVE
Practice Address - Street 2:STE B
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4897
Practice Address - Country:US
Practice Address - Phone:703-793-6033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000155364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health