Provider Demographics
NPI:1821351214
Name:CRADDOCK, MELANIE J (RN, CDCES)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:J
Last Name:CRADDOCK
Suffix:
Gender:F
Credentials:RN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1639
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-1639
Mailing Address - Country:US
Mailing Address - Phone:808-868-8968
Mailing Address - Fax:
Practice Address - Street 1:95 MAHALANI STREET RM 28-4
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-9217
Practice Address - Country:US
Practice Address - Phone:808-867-0623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI75952163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI75952OtherRN LICENSE
MT26831OtherRN LICENSE
32305624OtherCERTIFICATION BOARD FOR DIABETES CARE AND EDUCATION