Provider Demographics
NPI:1295581650
Name:CRAIG, JILL (LD, CNS)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:LD, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 CATTAIL WAY
Mailing Address - Street 2:APT. O
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440
Mailing Address - Country:US
Mailing Address - Phone:937-902-2569
Mailing Address - Fax:
Practice Address - Street 1:370 CATTAIL WAY
Practice Address - Street 2:APT. O
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440
Practice Address - Country:US
Practice Address - Phone:937-902-2569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10438133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education