Provider Demographics
NPI:1609021914
Name:CRAIG, JANESSA (LM)
Entity Type:Individual
Prefix:
First Name:JANESSA
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:JANESSA
Other - Middle Name:
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMMT
Mailing Address - Street 1:608 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-3640
Mailing Address - Country:US
Mailing Address - Phone:479-549-3240
Mailing Address - Fax:
Practice Address - Street 1:608 S MADISON ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3640
Practice Address - Country:US
Practice Address - Phone:479-549-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR69125176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife