Provider Demographics
NPI:1134662737
Name:CRAIG, MELANIE (RN)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9958 KIKA CT
Mailing Address - Street 2:APT. 5827
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-5072
Mailing Address - Country:US
Mailing Address - Phone:619-508-9555
Mailing Address - Fax:
Practice Address - Street 1:9958 KIKA CT
Practice Address - Street 2:APT. 5827
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-5027
Practice Address - Country:US
Practice Address - Phone:619-508-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95077367163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse