Provider Demographics
NPI:1245739929
Name:CRAFT, DELISA
Entity Type:Individual
Prefix:MRS
First Name:DELISA
Middle Name:
Last Name:CRAFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3343 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1428
Mailing Address - Country:US
Mailing Address - Phone:414-331-5896
Mailing Address - Fax:
Practice Address - Street 1:3343 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-1428
Practice Address - Country:US
Practice Address - Phone:414-331-5896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty