Provider Demographics
NPI:1063655777
Name:CRAVER, DOMINIQUE K (NP)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:K
Last Name:CRAVER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:K
Other - Last Name:ZENON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:DEPT 20-6000
Mailing Address - Street 2:PO BOX 5990
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-5990
Mailing Address - Country:US
Mailing Address - Phone:630-785-9100
Mailing Address - Fax:
Practice Address - Street 1:1 INGALLS DR
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-3558
Practice Address - Country:US
Practice Address - Phone:708-332-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007441363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner