Healthcare Provider Details

I. General information

NPI: 1104825157
Provider Name (Legal Business Name): APRIL CRAGO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 COMMERCIAL AVE SE BOX 259
HIGHMORE SD
57345
US

IV. Provider business mailing address

PO BOX 259
HIGHMORE SD
57345-0259
US

V. Phone/Fax

Practice location:
  • Phone: 605-852-2238
  • Fax:
Mailing address:
  • Phone: 605-852-2238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0545
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: