Provider Demographics
NPI:1720377898
Name:MCRAE, JULIE JEAN (NP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:JEAN
Last Name:MCRAE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MCRAE
Other - Last Name:CRANSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:6135 KING RD STE A
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-8877
Mailing Address - Country:US
Mailing Address - Phone:916-652-0428
Mailing Address - Fax:
Practice Address - Street 1:6135 KING RD STE A
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650-8877
Practice Address - Country:US
Practice Address - Phone:916-652-0427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2023-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9285363LF0000X
CANP9285363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP9285OtherNP LICENSE