Healthcare Provider Details

I. General information

NPI: 1558960849
Provider Name (Legal Business Name): JANE CRAIGO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 08/28/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 S MAIN ST
HEBER CITY UT
84032-2044
US

IV. Provider business mailing address

136 S MAIN ST
HEBER CITY UT
84032-2044
US

V. Phone/Fax

Practice location:
  • Phone: 435-680-8079
  • Fax:
Mailing address:
  • Phone: 435-680-8079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10640567-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number10640567-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number10640567-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: