Provider Demographics
NPI:1992305817
Name:CRAIG, ANNMARIE
Entity type:Individual
Prefix:
First Name:ANNMARIE
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNMARIE
Other - Middle Name:
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPCHCP
Mailing Address - Street 1:2900 W DARLEEN DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-0700
Mailing Address - Country:US
Mailing Address - Phone:928-225-8208
Mailing Address - Fax:928-440-3357
Practice Address - Street 1:2900 W DARLEEN DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-0700
Practice Address - Country:US
Practice Address - Phone:928-225-8208
Practice Address - Fax:928-440-3357
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20-V1-011405300000X
AZAZ036353747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No405300000XOther Service ProvidersPrevention Professional