Provider Demographics
NPI:1417941667
Name:MCCRAY, BONITA F (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BONITA
Middle Name:F
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:1523 HERITAGE LN
Mailing Address - Street 2:UNIT B
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-3197
Mailing Address - Country:US
Mailing Address - Phone:908-494-8467
Mailing Address - Fax:888-472-5145
Practice Address - Street 1:1523 HERITAGE LN
Practice Address - Street 2:UNIT B
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-3197
Practice Address - Country:US
Practice Address - Phone:908-494-8467
Practice Address - Fax:888-472-5145
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCAPN723363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ31267Medicare UPIN