Healthcare Provider Details

I. General information

NPI: 1619376266
Provider Name (Legal Business Name): LAUREN MCRAE DNP, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 MERIDIAN PKWY STE 323
DURHAM NC
27713-4232
US

IV. Provider business mailing address

2511 OLD CORNWALLIS RD STE 200
DURHAM NC
27713-1869
US

V. Phone/Fax

Practice location:
  • Phone: 984-227-8902
  • Fax: 844-813-6747
Mailing address:
  • Phone: 919-932-5700
  • Fax: 919-933-6881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5007030
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number5007030
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5007030
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: