Provider Demographics
NPI:1497464424
Name:CRAIG, TAMMY MICHELLE
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:MICHELLE
Last Name:CRAIG
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 1:400 S LONG ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62565-2100
Mailing Address - Country:US
Mailing Address - Phone:217-994-4101
Mailing Address - Fax:
Practice Address - Street 1:400 S LONG ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565-2100
Practice Address - Country:US
Practice Address - Phone:217-994-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0000OtherNA