Healthcare Provider Details

I. General information

NPI: 1285621888
Provider Name (Legal Business Name): KIMBERLY SUE CRAIG D. N. P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 01/19/2025
Certification Date: 01/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 WASHINGTON AVE N FL 2
MINNEAPOLIS MN
55401-2503
US

IV. Provider business mailing address

121 WASHINGTON AVE N FL 2
MINNEAPOLIS MN
55401-2503
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax:
Mailing address:
  • Phone: 888-731-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP010154
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: