Provider Demographics
NPI:1548360720
Name:MCRAE, ELISABETH UPSHAW (CPNP, IBCLC)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:UPSHAW
Last Name:MCRAE
Suffix:
Gender:F
Credentials:CPNP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5354
Mailing Address - Country:US
Mailing Address - Phone:434-296-9161
Mailing Address - Fax:
Practice Address - Street 1:1011 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5354
Practice Address - Country:US
Practice Address - Phone:434-296-9161
Practice Address - Fax:434-296-1036
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001063672163WP0200X
VA0024063672363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics