Healthcare Provider Details

I. General information

NPI: 1316730716
Provider Name (Legal Business Name): DEJA CRAYTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3546 HIGHWOODS DR N
INDIANAPOLIS IN
46222-1827
US

IV. Provider business mailing address

3546 HIGHWOODS DR N
INDIANAPOLIS IN
46222-1827
US

V. Phone/Fax

Practice location:
  • Phone: 317-789-6457
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number2822613A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: