Provider Demographics
NPI:1447859731
Name:CRAIG, CINDY CLARE (AGNP-C)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:CLARE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12100 DIX TOLEDO RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-3531
Mailing Address - Country:US
Mailing Address - Phone:734-282-5502
Mailing Address - Fax:734-282-7106
Practice Address - Street 1:4142 CRANBERRY LN
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690-8641
Practice Address - Country:US
Practice Address - Phone:231-735-3551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704313202363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care