Provider Demographics
NPI:1073601068
Name:CRAIG, CONNIE K (PHD ARNP)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:K
Last Name:CRAIG
Suffix:
Gender:F
Credentials:PHD ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7460 W MERCER WAY
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-5537
Mailing Address - Country:US
Mailing Address - Phone:206-406-7539
Mailing Address - Fax:425-746-2148
Practice Address - Street 1:14929 SE ALLEN RD
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1639
Practice Address - Country:US
Practice Address - Phone:425-746-2124
Practice Address - Fax:425-746-2148
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003200103TC0700X
WAAP30004761363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health