MEDICARE: MRS. LAURA A CRAIG RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN184009	AZ

General Provider Information

NPI Number	:	1568918464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA A CRAIG RN

Provider Business Mailing Address
First Line	:	31619 N 20TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-7068
Country	:	US
Telephone Number	:	816-914-4594
Fax Number	:

Provider Business Practice Location Address
First Line	:	35707 N 33RD LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-2289
Country	:	US
Telephone Number	:	623-445-7800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	08/30/2016

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