Provider Demographics
NPI:1023228921
Name:MCRAE, GAIL (LPN)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:
Last Name:MCRAE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 CLARK AVE
Mailing Address - Street 2:APT. 2
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-1144
Mailing Address - Country:US
Mailing Address - Phone:585-544-7898
Mailing Address - Fax:
Practice Address - Street 1:184 CLARK AVE
Practice Address - Street 2:APT. 2
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-1144
Practice Address - Country:US
Practice Address - Phone:585-544-7898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208579164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02206655Medicaid