Provider Demographics
NPI:1407685159
Name:MCRAE, CHRISTINA ESTHER
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ESTHER
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 1:2515 CASEY DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-1818
Mailing Address - Country:US
Mailing Address - Phone:702-701-0173
Mailing Address - Fax:
Practice Address - Street 1:7361 PRAIRIE FALCON RD STE 130A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0823
Practice Address - Country:US
Practice Address - Phone:725-212-1347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCHW1-5685172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker