Provider Demographics
NPI:1538399407
Name:CRAIG, ANNETTE KAYE (STNA)
Entity type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:KAYE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 KING ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-7118
Mailing Address - Country:US
Mailing Address - Phone:419-775-5288
Mailing Address - Fax:
Practice Address - Street 1:611 KING ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-7118
Practice Address - Country:US
Practice Address - Phone:419-775-5288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400250460603376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide