Provider Demographics
NPI:1841860822
Name:CRAIG, BRENDA LYNN (CPMC, NBHWC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LYNN
Last Name:CRAIG
Suffix:
Gender:F
Credentials:CPMC, NBHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 N BOLIVAR RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1969
Mailing Address - Country:US
Mailing Address - Phone:509-991-1144
Mailing Address - Fax:
Practice Address - Street 1:1316 N BOLIVAR RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1969
Practice Address - Country:US
Practice Address - Phone:509-991-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
0143OtherSOLO PRACTICE NON-MEDICARE