MEDICARE: MRS. DOROTHY MARIE CRAIG NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	28072176A	IN
2	363LW0102X	Women's Health Nurse Practitioner	71003879A	IN

General Provider Information

NPI Number	:	1336412345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DOROTHY MARIE CRAIG NP

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 W 10TH ST STE 1001
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3011
Country	:	US
Telephone Number	:	317-274-8812
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2012
Last Update Date	:	01/13/2021

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