Provider Demographics
NPI:1649329301
Name:CRAIG, MICHELLE R (RD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:CRAIG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1668 WHITE FIR TER
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-8009
Mailing Address - Country:US
Mailing Address - Phone:720-448-4863
Mailing Address - Fax:
Practice Address - Street 1:1668 WHITE FIR TER
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-8009
Practice Address - Country:US
Practice Address - Phone:720-448-4863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD5965133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCRMT74181Medicare ID - Type Unspecified