Provider Demographics
NPI:1679246250
Name:CRAIG, RACHAEL A (APN)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:A
Last Name:CRAIG
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 EISENHOWER ST
Mailing Address - Street 2:
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828-1605
Mailing Address - Country:US
Mailing Address - Phone:973-347-5612
Mailing Address - Fax:
Practice Address - Street 1:65 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1313
Practice Address - Country:US
Practice Address - Phone:973-401-1100
Practice Address - Fax:973-401-1201
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO11743700163W00000X
NJ26NJ01180900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse