Provider Demographics
NPI:1205362142
Name:WYSK, CRAIG
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:WYSK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 S 9TH ST
Mailing Address - Street 2:SUITE #110
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5851
Mailing Address - Country:US
Mailing Address - Phone:701-328-3941
Mailing Address - Fax:701-328-3968
Practice Address - Street 1:921 S 9TH ST
Practice Address - Street 2:SUITE #110
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5851
Practice Address - Country:US
Practice Address - Phone:701-328-3941
Practice Address - Fax:701-328-3968
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator