Individual
BERNICE MCCRAE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1311 NW 98TH TER, MIAMI, FL 33147-2663
(305) 696-5106
Mailing address
1311 NW 98TH TER, MIAMI, FL 33147-2663
(305) 696-5106
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
CHS 0307-701-88
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
230498800
MEDICAID PROBVIDER NUMBER
FL
Enumeration date
05/06/2008
Last updated
05/06/2008
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