Provider Demographics
NPI:1356958078
Name:CRAFT, RONALD
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:CRAFT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 S KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2615
Mailing Address - Country:US
Mailing Address - Phone:419-733-1067
Mailing Address - Fax:
Practice Address - Street 1:1425 S KNOXVILLE AVE
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2615
Practice Address - Country:US
Practice Address - Phone:419-733-1067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide