Provider Demographics
NPI:1013207448
Name:CRAIG, JESSICA LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:CRAIG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39271 DORY MILL RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:OH
Mailing Address - Zip Code:43719-9725
Mailing Address - Country:US
Mailing Address - Phone:740-359-2179
Mailing Address - Fax:
Practice Address - Street 1:39271 DORY MILL RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:OH
Practice Address - Zip Code:43719-9725
Practice Address - Country:US
Practice Address - Phone:740-359-2179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.144443-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3064008Medicaid