Provider Demographics
NPI:1619101029
Name:CRAIG, RHONDA DIANE (RN)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:DIANE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9911 MITCHELL CT
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-1921
Mailing Address - Country:US
Mailing Address - Phone:314-423-1191
Mailing Address - Fax:
Practice Address - Street 1:9911 MITCHELL CT
Practice Address - Street 2:
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-1921
Practice Address - Country:US
Practice Address - Phone:314-423-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO081394163WH0500X
IL041.350523163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysis