Provider Demographics
NPI:1770807638
Name:CRAFT, JUDITH ELLA-MARIAN
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ELLA-MARIAN
Last Name:CRAFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5713 CYPRESS CREEK DR
Mailing Address - Street 2:APT 202
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1823
Mailing Address - Country:US
Mailing Address - Phone:504-914-3665
Mailing Address - Fax:
Practice Address - Street 1:5713 CYPRESS CREEK DR
Practice Address - Street 2:APT 202
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-1823
Practice Address - Country:US
Practice Address - Phone:504-914-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program