Basic Information
| Provider Information | |||||||||
| NPI: | 1073681672 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CREHAN | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14890 | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122124890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185255634 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 501 NEW KARNER RD | ||||||||
| Address2: | SUITE 1A | ||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122053882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184521337 | ||||||||
| FaxNumber: | 5177246660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 05/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 05/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 331344 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 113661 | 01 | NY | GHI HMO | OTHER | 4151599 | 01 | NY | MVP | OTHER | 000493818003 | 01 | NY | BSNENY | OTHER | 01803814 | 05 | NY | MEDICAID | 070425000034 | 01 | NY | FIDELIS | OTHER | 201113 | 01 | NY | SENIOR WHOLE HEALTH | OTHER |