Basic Information
| Provider Information | |||||||||
| NPI: | 1902266463 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAIG | ||||||||
| FirstName: | MERRIANN | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2027 MAPLEGROVE AVE | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454145213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373719716 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1725 E 3RD ST | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454031850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373876395 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2016 | ||||||||
| LastUpdateDate: | 01/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | PN.125397-M-IV | OH | N | Nursing Service Providers | Licensed Practical Nurse | 163W00000X | RN.437731 | OH | Y | Nursing Service Providers | Registered Nurse |
No ID Information.