Provider Demographics
NPI:1245898246
Name:MCRAE, CALVIN D (LVN)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:D
Last Name:MCRAE
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3718 BLUE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-5109
Mailing Address - Country:US
Mailing Address - Phone:817-528-8946
Mailing Address - Fax:
Practice Address - Street 1:3718 BLUE LAKE DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-5109
Practice Address - Country:US
Practice Address - Phone:830-928-8626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX132756164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse