Provider Demographics
NPI:1942497300
Name:CRADDOCK, PAMELA R (CNM)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:CRADDOCK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:TERRE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17581-0728
Mailing Address - Country:US
Mailing Address - Phone:717-445-5940
Mailing Address - Fax:717-445-5251
Practice Address - Street 1:214 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:TERRE HILL
Practice Address - State:PA
Practice Address - Zip Code:17581
Practice Address - Country:US
Practice Address - Phone:717-445-5940
Practice Address - Fax:717-445-5251
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008479L176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife