Provider Demographics
NPI:1881204378
Name:MCRAE, DEBRA LYNN
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:MCRAE
Suffix:
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 1:2603 LAGUNA DR
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-2796
Mailing Address - Country:US
Mailing Address - Phone:907-250-6526
Mailing Address - Fax:
Practice Address - Street 1:722 CATTAIL CIR
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-2657
Practice Address - Country:US
Practice Address - Phone:907-250-6526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-09
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232177164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse