MEDICARE: MS. JEAN MACRAE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WD0400X	Diabetes Educator Registered Nurse	444674	TX

General Provider Information

NPI Number	:	1134245970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEAN MACRAE RN

Provider Business Mailing Address
First Line	:	PO BOX 6180
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77325-6180
Country	:	US
Telephone Number	:	281-358-3387
Fax Number	:

Provider Business Practice Location Address
First Line	:	24046 HIGHWAY 59 N
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-1500
Country	:	US
Telephone Number	:	281-358-3387
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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