Provider Demographics
NPI:1831213966
Name:CRAIG, LYNELLEN C (RN)
Entity type:Individual
Prefix:
First Name:LYNELLEN
Middle Name:C
Last Name:CRAIG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4504 BOAT CLUB RD
Mailing Address - Street 2:STE 800
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-7003
Mailing Address - Country:US
Mailing Address - Phone:817-237-4794
Mailing Address - Fax:817-237-4880
Practice Address - Street 1:7100 OAKMONT BLVD
Practice Address - Street 2:STE 207
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3900
Practice Address - Country:US
Practice Address - Phone:817-370-5950
Practice Address - Fax:817-370-5953
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX612690163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612690OtherSTATE LICENSE