Provider Demographics
NPI:1841583895
Name:MCRAE, ANNIE E (NC)
Entity type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:E
Last Name:MCRAE
Suffix:
Gender:F
Credentials:NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5348 TOPANGA CANYON BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1739
Mailing Address - Country:US
Mailing Address - Phone:310-310-4889
Mailing Address - Fax:
Practice Address - Street 1:5348 TOPANGA CANYON BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1739
Practice Address - Country:US
Practice Address - Phone:310-310-4889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist