Provider Demographics
NPI:1033698691
Name:MCCRAY, QUINYATTA
Entity Type:Individual
Prefix:
First Name:QUINYATTA
Middle Name:
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:QUINYATTA
Other - Middle Name:LYNN
Other - Last Name:MCCRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3835 W FILLMORE ST # 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60624-4204
Mailing Address - Country:US
Mailing Address - Phone:312-672-2263
Mailing Address - Fax:
Practice Address - Street 1:3835 W FILLMORE ST # 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-4204
Practice Address - Country:US
Practice Address - Phone:312-672-2263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide