Provider Demographics
NPI:1669087201
Name:MCRAE, JANUARY
Entity type:Individual
Prefix:
First Name:JANUARY
Middle Name:
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 1:9 OAKWOOD DR APT 151
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-1937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CLOVER HEALTH SERVICES
Practice Address - Street 2:75 SOUTH BROADWAY
Practice Address - City:WHITEFIELDS
Practice Address - State:NY
Practice Address - Zip Code:10601
Practice Address - Country:US
Practice Address - Phone:203-409-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY764422163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse