Provider Demographics
NPI:1003363391
Name:MCCRAYER, GENEVA (LPN)
Entity Type:Individual
Prefix:
First Name:GENEVA
Middle Name:
Last Name:MCCRAYER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 DELAWARE AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1007
Mailing Address - Country:US
Mailing Address - Phone:716-882-3151
Mailing Address - Fax:716-886-4022
Practice Address - Street 1:28 ENOLA AVE LOWR
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1708
Practice Address - Country:US
Practice Address - Phone:716-510-7144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323374164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse