Provider Demographics
NPI:1477867901
Name:CRAIG, TRACY LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:CRAIG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 N HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2605
Mailing Address - Country:US
Mailing Address - Phone:740-701-8455
Mailing Address - Fax:
Practice Address - Street 1:99 N HICKORY ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2605
Practice Address - Country:US
Practice Address - Phone:740-701-8455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN103153164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse