Provider Demographics
NPI:1235438003
Name:CRAYCRAFT, DAVID K
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:K
Last Name:CRAYCRAFT
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 1:15880 STANTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST OLIVE
Mailing Address - State:MI
Mailing Address - Zip Code:49460-8972
Mailing Address - Country:US
Mailing Address - Phone:616-795-3506
Mailing Address - Fax:616-850-0257
Practice Address - Street 1:15880 STANTON ST
Practice Address - Street 2:
Practice Address - City:WEST OLIVE
Practice Address - State:MI
Practice Address - Zip Code:49460-8972
Practice Address - Country:US
Practice Address - Phone:616-795-3506
Practice Address - Fax:616-850-0257
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-19
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide