Provider Demographics
NPI:1184213324
Name:MCRAE, TYSHIMA NACHEY
Entity Type:Individual
Prefix:
First Name:TYSHIMA
Middle Name:NACHEY
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 1:20 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-2602
Mailing Address - Country:US
Mailing Address - Phone:609-598-1971
Mailing Address - Fax:
Practice Address - Street 1:16 W FRONT ST # 220
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08608-2010
Practice Address - Country:US
Practice Address - Phone:609-695-1977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty