Provider Demographics
NPI:1104821644
Name:CRAVEN, NICOLE J (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:J
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3288 ROBINHOOD RD STE 202
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5464
Mailing Address - Country:US
Mailing Address - Phone:336-768-3335
Mailing Address - Fax:
Practice Address - Street 1:3288 ROBINHOOD RD STE 202
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5464
Practice Address - Country:US
Practice Address - Phone:336-209-5884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004-01378208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2468828OtherUNITED HEALTHCARE
NC13837OtherBLUE CROSS PROVIDER #
NC7280705OtherAETNA
NC5908891Medicaid
NCI20055Medicare UPIN