Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | SP012593 | PA |
N | 363LP2300X | Nurse Practitioner - Primary Care | SP012593 | PA |
NPI | 1093050759 |
---|---|
Provider Name | Jennifer L Craig |
First Address | Lansdale, PA 19446-2321 |
Second Address | Lansdale, PA 19446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2012 |
Last Update Date | 17/07/2018 |