Provider Demographics
NPI:1124891890
Name:MCRAE, STEVEN L
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:MCRAE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9095 HOSSTON VIVIAN RD
Mailing Address - Street 2:
Mailing Address - City:VIVIAN
Mailing Address - State:LA
Mailing Address - Zip Code:71082-8870
Mailing Address - Country:US
Mailing Address - Phone:318-465-7368
Mailing Address - Fax:
Practice Address - Street 1:9095 HOSSTON VIVIAN RD
Practice Address - Street 2:
Practice Address - City:VIVIAN
Practice Address - State:LA
Practice Address - Zip Code:71082-8870
Practice Address - Country:US
Practice Address - Phone:318-465-7368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA231740363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine