Individual
MS. IDA MCCRAE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1 HOSPITAL DR, DONIPHAN, MO 63935-1274
(573) 996-7148
(573) 996-4041
Mailing address
PO BOX 989, POPLAR BLUFF, MO 63902-0989
(573) 778-0020
(573) 778-1647
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
086500
MO
Other
Enumeration date
04/19/2006
Last updated
02/27/2012
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