1750594966 NPI number — HEATHER RAE CRAVER PCC-S

Table of content: HEATHER RAE CRAVER PCC-S (NPI 1750594966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750594966 NPI number — HEATHER RAE CRAVER PCC-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAVER
Provider First Name:
HEATHER
Provider Middle Name:
RAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PCC-S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750594966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4874 FAIRPORT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON FALLS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44444-9503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-872-6427
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 E PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NILES
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44446-2352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-544-8005
Provider Business Practice Location Address Fax Number:
330-544-9379
Provider Enumeration Date:
05/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  E0003846 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YS0200X , with the licence number: OH1-49-8631 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)