Provider Demographics
NPI:1538643929
Name:MCCART, RAEANN L (LMT)
Entity Type:Individual
Prefix:
First Name:RAEANN
Middle Name:L
Last Name:MCCART
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11354 N GOVERNMENT WAY
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-7289
Mailing Address - Country:US
Mailing Address - Phone:208-714-7257
Mailing Address - Fax:
Practice Address - Street 1:11354 N GOVERNMENT WAY
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-7289
Practice Address - Country:US
Practice Address - Phone:208-714-7257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath