| Doctor Name: | MS. IDA MCCRAE |
| NPI Number: | 1003871393 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 086500 |
| Business Practice Address: | 1 Hospital Dr Doniphan, MO - 639351274 |
| Business Phone Number: | 5739967148 |
| Business Fax Number: | 5739964041 |
| Mailing Address: | Po Box 989, POPLAR BLUFF |
| State: | MO |
| Postal Code: | 639020989 |
| Phone Number: | 5737780020 |
| Fax Number: | 5737781647 |
| NPI Enumeration Date: | 04/19/2006 |
| NPI Last Update Date: | 02/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 086500 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |