Provider Demographics
NPI:1609350529
Name:CRAIG, NATALIE GRACE (LMT, LPN)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:GRACE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:LMT, LPN
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:GRACE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, LPN
Mailing Address - Street 1:7008 MARY WAY
Mailing Address - Street 2:
Mailing Address - City:THREE LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:54562-9041
Mailing Address - Country:US
Mailing Address - Phone:715-544-5562
Mailing Address - Fax:
Practice Address - Street 1:7008 MARY WAY
Practice Address - Street 2:
Practice Address - City:THREE LAKES
Practice Address - State:WI
Practice Address - Zip Code:54562-9041
Practice Address - Country:US
Practice Address - Phone:715-544-5562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14640225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist