Provider Demographics
NPI:1356071468
Name:CRADDOLPH, NINA
Entity Type:Individual
Prefix:MS
First Name:NINA
Middle Name:
Last Name:CRADDOLPH
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:PO BOX 15404
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-0404
Mailing Address - Country:US
Mailing Address - Phone:614-588-6060
Mailing Address - Fax:
Practice Address - Street 1:1414 GAULT ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2933
Practice Address - Country:US
Practice Address - Phone:614-216-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No172A00000XOther Service ProvidersDriver