Provider Demographics
NPI:1730610353
Name:MCCRAE, TANAE (RN)
Entity type:Individual
Prefix:
First Name:TANAE
Middle Name:
Last Name:MCCRAE
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 1:2782 GROSSE PT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4877
Mailing Address - Country:US
Mailing Address - Phone:614-597-2811
Mailing Address - Fax:
Practice Address - Street 1:2782 GROSSE PT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4877
Practice Address - Country:US
Practice Address - Phone:614-597-2811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH156537164W00000X
OH481785163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse