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General NPI Number Information
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NPI Number | 1821351214
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Entity Type | Individual
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Provider Name | MELANIE J CRADDOCK RN, CDCES
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Gender | Female
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 95 MAHALANI STREET RM 28-4
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City | WAILUKU
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State | HI
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Zip | 96793-9217
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Country | US
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Telephone | 808-867-0623
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1639
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City | KIHEI
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State | HI
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Zip | 96753-1639
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Country | US
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Telephone | 808-868-8968
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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 | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 75952
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License Number State | HI
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