Provider Demographics
NPI:1679157168
Name:KRAFT, DONALD CHARLES (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:CHARLES
Last Name:KRAFT
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17259 W SALOME ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1827
Mailing Address - Country:US
Mailing Address - Phone:228-365-7046
Mailing Address - Fax:
Practice Address - Street 1:17259 W SALOME ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1827
Practice Address - Country:US
Practice Address - Phone:228-365-7046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ257348363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily