Provider Demographics
NPI:1437458940
Name:CRAIG, CAROL ANNE (NNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANNE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:NNP
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 1420
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-0400
Mailing Address - Country:US
Mailing Address - Phone:541-526-6556
Mailing Address - Fax:541-706-3765
Practice Address - Street 1:2500 NE NEFF RD
Practice Address - Street 2:ST. CHARLES MEDICAL GROUP
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6015
Practice Address - Country:US
Practice Address - Phone:541-526-6556
Practice Address - Fax:541-706-3765
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200850058NP363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal