Mary Ellen McCormick, CRNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

VP003894C Issued in PA

Practice address

150 Mundy St
Mac IV Building
Wilkes Barre, PA 18702-6830

Phone

(570) 824-0930

Fax

(570) 824-7755

NPI assigned

May 18, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northeastern Rehabilitation Associates, PC

  • Physical Medicine & Rehabilitation Physician
  • Scranton, PA
  • NPI 1104878412
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245283200000",
    "number": "1013960236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MUNDY STREET",
            "address_2": "MAC IV BUILDING",
            "city": "WILKES-BARRE",
            "state": "PA",
            "postal_code": "187026380",
            "telephone_number": "570-824-0930",
            "fax_number": "570-824-7755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MUNDY ST",
            "address_2": "MAC IV BUILDING",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187026830",
            "telephone_number": "570-824-0930",
            "fax_number": "570-824-7755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMICK",
        "first_name": "MARY ELLEN",
        "name_prefix": "Ms.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-18",
        "last_updated": "2009-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "VP003894C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "50076332",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Elizabeth McBride, PA-C
• Caitlin McClain
• Evan Lee McClennen, D.O.
• Hillary McConnell
• Maggie McCormack
• Paul McCue
• Michael P McDaniel
• Elizabeth M. McDonald, R.D.
• Heather Lynne McDonald, PSY.D.
• Sean McDonnell, OT

• Nurse Practitioner in Wilkes Barre, PA
• Providers in Wilkes Barre, PA by specialty
• Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.