Provider Demographics
NPI:1922622596
Name:MCRAE, CALISHA (RN)
Entity Type:Individual
Prefix:
First Name:CALISHA
Middle Name:
Last Name:MCRAE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 HOLDEN FOREST DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27596-7201
Mailing Address - Country:US
Mailing Address - Phone:919-791-7824
Mailing Address - Fax:
Practice Address - Street 1:404 HOLDEN FOREST DR
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27596-7201
Practice Address - Country:US
Practice Address - Phone:919-791-7824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC262638163W00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty