Provider Demographics
NPI:1194818708
Name:MCRAE, MICHELE L (ARNP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:MCRAE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:L
Other - Last Name:HORVATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 1166
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-1166
Mailing Address - Country:US
Mailing Address - Phone:425-258-7357
Mailing Address - Fax:425-258-7022
Practice Address - Street 1:900 PACIFIC AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4168
Practice Address - Country:US
Practice Address - Phone:425-304-6040
Practice Address - Fax:425-304-6045
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006470363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9642109Medicaid
WA9642109Medicaid
WAQ24630Medicare UPIN