Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP30006470 | WA |
NPI | 1194818708 |
---|---|
Provider Name | Michele L. Mcrae |
First Address | Everett, WA 98206-1166 |
Second Address | Everett, WA 98201-4168 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9642109 | (05) | WA |
Q24630 | (02) | WA |