Provider Demographics
NPI:1639052418
Name:CRAIG, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 FAITH ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IA
Mailing Address - Zip Code:52345-9076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2001 FAITH ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IA
Practice Address - Zip Code:52345-9076
Practice Address - Country:US
Practice Address - Phone:319-450-6276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA184956363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner