Provider Demographics
NPI:1699500157
Name:MCCRARY, LOIS ANNETTE (LVN)
Entity type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:ANNETTE
Last Name:MCCRARY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:ANNETTE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2720 E PALMDALE BLVD STE 129
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4930
Mailing Address - Country:US
Mailing Address - Phone:661-947-3333
Mailing Address - Fax:
Practice Address - Street 1:2720 E PALMDALE BLVD STE 129
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4930
Practice Address - Country:US
Practice Address - Phone:661-947-3333
Practice Address - Fax:661-575-2397
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAI121408164X00000X
CA121408164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse