1376640060 NPI number — MS. SARA CRAFT APN

Table of content: MS. SARA CRAFT APN (NPI 1376640060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376640060 NPI number — MS. SARA CRAFT APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAFT
Provider First Name:
SARA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APN
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:
1376640060
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 W UNIVERSITY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAMPAIGN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61820-3909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-366-8107
Provider Business Mailing Address Fax Number:
217-366-6106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 N LOGAN
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-431-8930
Provider Business Practice Location Address Fax Number:
217-431-1945
Provider Enumeration Date:
09/17/2006

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: 363L00000X , with the licence number:  209001908 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 209001908 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com