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General NPI Number Information
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NPI Number | 1982823373
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Entity Type | Individual
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Provider Name | ANN MARGARET CRADDOCK NP
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 04/14/2014
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Provider Practice Location Address
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Address Line | 81 MAKAWAO AVE
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City | MAKAWAO
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State | HI
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Zip | 96768-8895
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Country | US
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Telephone | 808-573-8900
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Fax | 808-572-3027
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Provider Business Mailing Address
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Address Line | 144 LANAKILA PL
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City | KIHEI
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State | HI
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Zip | 96753-8933
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Country | US
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Telephone | 808-268-2876
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP CERTIFICATE 16849
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | APRN
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | APRN763
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License Number State | HI
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