Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 237735 | AZ |
NPI | 1003442435 |
---|---|
Provider Name | James Bradley Craigo |
First Address | Phoenix, AZ 85013-4220 |
Second Address | Phoenix, AZ 85013-4220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2020 |
Last Update Date | 24/03/2020 |