Provider Demographics
NPI:1346284833
Name:CRAIG, DEENA LYNN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DEENA
Middle Name:LYNN
Last Name:CRAIG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 602458
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2458
Mailing Address - Country:US
Mailing Address - Phone:910-277-9164
Mailing Address - Fax:910-277-9189
Practice Address - Street 1:1600 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5524
Practice Address - Country:US
Practice Address - Phone:910-277-9164
Practice Address - Fax:910-277-9189
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-01780363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1790PAMedicaid
NC1346284833Medicaid
NCNC9505BMedicare PIN
FLE6345YMedicare PIN
SC1790PAMedicaid
P41671Medicare UPIN