| Doctor Name: | KENNETH MCRAE |
| NPI Number: | 1003290685 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CNP |
| License Number: | 3895 |
| Business Practice Address: | 15251 Pleasant Valley Rd Center City, MN - 550129640 |
| Business Phone Number: | 6512134277 |
| Business Fax Number: | |
| Mailing Address: | 15251 Pleasant Valley Rd, P.o. Box 11 CENTER CITY |
| State: | MN |
| Postal Code: | 550129640 |
| Phone Number: | 6512134277 |
| Fax Number: | |
| NPI Enumeration Date: | 07/14/2015 |
| NPI Last Update Date: | 09/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | 3895 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |