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General NPI Number Information
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NPI Number | 1477803104
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Entity Type | Individual
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Provider Name | MELISSA CRAIG PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/10/2012
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 4915 E BASELINE RD STE 126
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City | GILBERT
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State | AZ
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Zip | 85234-2969
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Country | US
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Telephone | 480-969-3096
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 748860
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City | ATLANTA
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State | GA
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Zip | 30374-8860
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Country | US
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Telephone | 480-969-3096
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5232
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License Number State | AZ
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