Provider Demographics
NPI:1366045700
Name:MCCRAE, MARIAH MICHELLE I
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:MICHELLE
Last Name:MCCRAE
Suffix:I
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 1:39242 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-5342
Mailing Address - Country:US
Mailing Address - Phone:971-335-6740
Mailing Address - Fax:
Practice Address - Street 1:18980 LELAND RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-8511
Practice Address - Country:US
Practice Address - Phone:503-650-8605
Practice Address - Fax:503-387-3452
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant