Provider Demographics
NPI:1831481878
Name:CRAFT, CASSIE DORA (LPN)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:DORA
Last Name:CRAFT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6712 WISCOY MILLS MILLS RD
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14735-8657
Mailing Address - Country:US
Mailing Address - Phone:585-356-7757
Mailing Address - Fax:
Practice Address - Street 1:82 OLIVE ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:NY
Practice Address - Zip Code:14715-1310
Practice Address - Country:US
Practice Address - Phone:585-928-1901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257577-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse