Provider Demographics
NPI:1255172581
Name:RAE, JOANNE MACPHERSON
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:MACPHERSON
Last Name:RAE
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 1:591 MIDNIGHT PASS
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-2473
Mailing Address - Country:US
Mailing Address - Phone:847-682-0597
Mailing Address - Fax:
Practice Address - Street 1:24238 W BAYVIEW RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-9566
Practice Address - Country:US
Practice Address - Phone:847-514-1412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider