Provider Demographics
NPI:1184199440
Name:CRAIG, ILEEN M (RN)
Entity Type:Individual
Prefix:
First Name:ILEEN
Middle Name:M
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 1:5937 E HIGHWAY 72
Mailing Address - Street 2:
Mailing Address - City:PATHFORK
Mailing Address - State:KY
Mailing Address - Zip Code:40863-6517
Mailing Address - Country:US
Mailing Address - Phone:606-505-8270
Mailing Address - Fax:
Practice Address - Street 1:1203 AMERICAN GREETING CARD RD
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-4811
Practice Address - Country:US
Practice Address - Phone:606-528-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist