Healthcare Provider Details

I. General information

NPI: 1841371259
Provider Name (Legal Business Name): TRACI LEE CRAVER NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE RBC6010
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

5272 SPENCER RD
LYNDHURST OH
44124-1251
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-1922
  • Fax:
Mailing address:
  • Phone: 440-442-0265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberRN197475 NP-03312
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: