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General NPI Number Information
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NPI Number | 1932680725
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Entity Type | Individual
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Provider Name | RITA LEE CRAVEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/28/2018
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 100 GORE RD
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City | MORRIS
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State | IL
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Zip | 60450-9466
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Country | US
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Telephone | 815-364-8919
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Fax |
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Provider Business Mailing Address
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Address Line | 8224 W WOODVALE RD
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City | FRANKFORT
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State | IL
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Zip | 60423-9171
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Country | US
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Telephone |
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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 | IL
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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 | 085006800
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License Number State | IL
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