Provider Demographics
NPI:1902076318
Name:CRAIG, HOLLY L (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:L
Last Name:CRAIG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 S BLACK HORSE PIKE STE 104
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2958
Mailing Address - Country:US
Mailing Address - Phone:856-292-8216
Mailing Address - Fax:856-848-3011
Practice Address - Street 1:141 S BLACK HORSE PIKE STE 104
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-2958
Practice Address - Country:US
Practice Address - Phone:856-292-8216
Practice Address - Fax:856-848-3011
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008042363LF0000X
DELG-0000584363LF0000X
DELG0000584363L00000X
NJ26NJ00451600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0393011Medicaid
NJ339580X1UMedicare PIN