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NPI Code Detail

MEDICARE: OWEN MCRAE

MEDICARE: OWEN MCRAE
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
1367500000XCertified Registered Nurse Anesthetist330492AZ
2367500000XCertified Registered Nurse AnesthetistRN176023AZ

General Provider Information

NPI Number : 1558236125
Entity Type Code : Individual
Provider Name (Legal Business Name) : OWEN MCRAE
Provider Business Mailing Address
First Line : 1550 N STAPLEY DR UNIT 1
Second Line :
City : MESA
State : AZ
Zip : 85203-3701
Country : US
Telephone Number : 480-980-6176
Fax Number :
Provider Business Practice Location Address
First Line : 6644 E BAYWOOD AVE
Second Line :
City : MESA
State : AZ
Zip : 85206-1747
Country : US
Telephone Number : 480-321-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2025
Last Update Date : 12/09/2025

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Directions to “ OWEN MCRAE ” Practice Location

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