Provider Demographics
NPI:1306262985
Name:MCRAE, WONITA
Entity type:Individual
Prefix:
First Name:WONITA
Middle Name:
Last Name:MCRAE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 E 21ST ST
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7201
Mailing Address - Country:US
Mailing Address - Phone:347-424-5527
Mailing Address - Fax:
Practice Address - Street 1:617 E 21ST ST
Practice Address - Street 2:APARTMENT 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7201
Practice Address - Country:US
Practice Address - Phone:347-424-5527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY697431121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist