Provider Demographics
NPI:1295138733
Name:CRAIG, KATHLEEN A (LPN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:CRAIG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 STATE ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-1470
Mailing Address - Country:US
Mailing Address - Phone:607-435-8497
Mailing Address - Fax:
Practice Address - Street 1:611 STATE ST
Practice Address - Street 2:APT. 2
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-1470
Practice Address - Country:US
Practice Address - Phone:607-435-8497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248551164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse