Provider Demographics
NPI:1629382742
Name:CRAGO, MARCELLE
Entity Type:Individual
Prefix:
First Name:MARCELLE
Middle Name:
Last Name:CRAGO
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 1:5 VIKING LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-2308
Mailing Address - Country:US
Mailing Address - Phone:845-679-0198
Mailing Address - Fax:
Practice Address - Street 1:5 VIKING LN
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-2308
Practice Address - Country:US
Practice Address - Phone:845-679-0198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY526904163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse