Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 600020 | NC |
NPI | 1003079450 |
---|---|
Provider Name | Susan Lill Craven |
First Address | Faison, NC 28341-0187 |
Second Address | Hamlet, NC 28345-3100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2008 |
Last Update Date | 05/07/2017 |