Provider Demographics
NPI:1134294838
Name:CRAIG, LINDA W (MSN RN CS)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:W
Last Name:CRAIG
Suffix:
Gender:F
Credentials:MSN RN CS
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:C
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN MSN
Mailing Address - Street 1:PO BOX 1102
Mailing Address - Street 2:101 MAIN ST SUITE #5
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326
Mailing Address - Country:US
Mailing Address - Phone:607-547-1130
Mailing Address - Fax:607-547-1130
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:SUITE #5
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326
Practice Address - Country:US
Practice Address - Phone:607-547-1130
Practice Address - Fax:607-547-1130
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291456364S00000X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
387492OtherVALUE OPTIONS
161606008OtherEXCELLUS BCBS
P37653Medicare UPIN
CC7112Medicare PIN