Healthcare Provider Details

I. General information

NPI: 1336060177
Provider Name (Legal Business Name): MARY ELIZABETH CRAYCRAFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 HELSINGER DR
MONROE OH
45050-1681
US

IV. Provider business mailing address

880 HELSINGER DR
MONROE OH
45050-1681
US

V. Phone/Fax

Practice location:
  • Phone: 513-292-1431
  • Fax:
Mailing address:
  • Phone: 513-292-1431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: