Healthcare Provider Details

I. General information

NPI: 1801188768
Provider Name (Legal Business Name): PATRICIA MCRAE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 PICARDY AVE
BATON ROUGE LA
70809-3679
US

IV. Provider business mailing address

PO BOX 4869 DEPT: 237
HOUSTON TX
77210-4869
US

V. Phone/Fax

Practice location:
  • Phone: 225-763-4670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP02386
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: