Basic Information
| Provider Information | |||||||||
| NPI: | 1154577542 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAGGS | ||||||||
| FirstName: | LILLIAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | R.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5200 SW 4TH ST | ||||||||
| Address2: | |||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333173612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546848731 | ||||||||
| FaxNumber: | 9545872648 | ||||||||
| Practice Location | |||||||||
| Address1: | 2950 CLEVELAND CLINIC BLVD | ||||||||
| Address2: | |||||||||
| City: | WESTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333313609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546595872 | ||||||||
| FaxNumber: | 9546595256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2008 | ||||||||
| LastUpdateDate: | 08/18/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | ND4169 | FL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.