Provider Demographics
NPI:1093245144
Name:CRAIG, MARIAH (CHP)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:CHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:GAKONA
Mailing Address - State:AK
Mailing Address - Zip Code:99586-0357
Mailing Address - Country:US
Mailing Address - Phone:907-822-5399
Mailing Address - Fax:907-822-5810
Practice Address - Street 1:MILE 5.9 MENTASTA SPUR ROAD
Practice Address - Street 2:
Practice Address - City:MENTASTA LAKE
Practice Address - State:AK
Practice Address - Zip Code:99780
Practice Address - Country:US
Practice Address - Phone:907-822-3280
Practice Address - Fax:907-822-3944
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12-1185-P172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker