Healthcare Provider Details

I. General information

NPI: 1184007015
Provider Name (Legal Business Name): KRISTEN MACRAE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 PRESTON AVE
IONE CA
95640-9158
US

IV. Provider business mailing address

305 PRESTON AVE
IONE CA
95640-9158
US

V. Phone/Fax

Practice location:
  • Phone: 209-274-2183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002567
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: