Provider Demographics
NPI:1952675175
Name:CRAVER, MARJORY (NP-C)
Entity Type:Individual
Prefix:
First Name:MARJORY
Middle Name:
Last Name:CRAVER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5883 SNYDER DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-9497
Mailing Address - Country:US
Mailing Address - Phone:716-438-3890
Mailing Address - Fax:715-438-3894
Practice Address - Street 1:5883 SNYDER DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-9497
Practice Address - Country:US
Practice Address - Phone:716-438-3890
Practice Address - Fax:715-438-3894
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2012-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30306037363LA2200X
NY328521163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical