Provider Demographics
NPI:1912331224
Name:CRAIG, WILLA PEARL (LPN)
Entity Type:Individual
Prefix:
First Name:WILLA
Middle Name:PEARL
Last Name:CRAIG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5795 RESERVE CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-4191
Mailing Address - Country:US
Mailing Address - Phone:513-939-5509
Mailing Address - Fax:
Practice Address - Street 1:5795 RESERVE CT
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-4191
Practice Address - Country:US
Practice Address - Phone:513-939-5509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN153762-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse