Provider Demographics
NPI:1932971256
Name:CRAIL, CARISSA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:CRAIL
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:
Other - Last Name:KRUEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3433 CLOUDCROFT CT
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4836
Mailing Address - Country:US
Mailing Address - Phone:916-209-0629
Mailing Address - Fax:
Practice Address - Street 1:3433 CLOUDCROFT CT
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4836
Practice Address - Country:US
Practice Address - Phone:916-209-0629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-311904163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant