Provider Demographics
NPI:1891062089
Name:CRAIGMILE, TRACI L (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:L
Last Name:CRAIGMILE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:L
Other - Last Name:DIETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:310 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4516
Mailing Address - Country:US
Mailing Address - Phone:701-877-2020
Mailing Address - Fax:701-639-2465
Practice Address - Street 1:310 N 10TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4516
Practice Address - Country:US
Practice Address - Phone:701-877-2020
Practice Address - Fax:701-639-2465
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR30427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily