Provider Demographics
NPI:1982823373
Name:CRADDOCK, ANN MARGARET (NP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARGARET
Last Name:CRADDOCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 LANAKILA PL
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8933
Mailing Address - Country:US
Mailing Address - Phone:808-268-2876
Mailing Address - Fax:
Practice Address - Street 1:81 MAKAWAO AVE
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8895
Practice Address - Country:US
Practice Address - Phone:808-573-8900
Practice Address - Fax:808-572-3027
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP CERTIFICATE 16849363L00000X
HIAPRN363LW0102X
HIAPRN763363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner