Provider Demographics
NPI:1851814263
Name:HEASLIP, CRAIG OWEN (ATP)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:OWEN
Last Name:HEASLIP
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3112
Mailing Address - Country:US
Mailing Address - Phone:575-526-4500
Mailing Address - Fax:505-345-6511
Practice Address - Street 1:2301 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3112
Practice Address - Country:US
Practice Address - Phone:575-526-4500
Practice Address - Fax:505-345-6511
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty