Healthcare Provider Details

I. General information

NPI: 1265750699
Provider Name (Legal Business Name): ELIZABETH ALICE CRACRAFT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 05/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC BAVARIA CMR 411, BLDG 700, ROSE BARRACKS
APO AE
09112
US

IV. Provider business mailing address

850 N DEWITT PL APT 16K
CHICAGO IL
60611-2361
US

V. Phone/Fax

Practice location:
  • Phone: 011499662834719
  • Fax: 011499662834121
Mailing address:
  • Phone: 312-944-5812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.337133
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: