Individual provider Active NPI

Holly L. Craig, CRNP

  • Family Nurse Practitioner
  • Blackwood, NJ
National Provider Identifier
1902076318
Registry record updated Mar 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
26NJ00451600 Issued in NJ
Practice address
141 S Black Horse Pike Ste 104
Blackwood, NJ 08012-2958
Phone
(856) 292-8216
Fax
(856) 848-3011
NPI assigned
Mar 3, 2008
Last updated
Mar 17, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X LG0000584 DE
Family Nurse Practitioner 363LF0000X SP008042 PA
Family Nurse Practitioner 363LF0000X LG-0000584 DE
Family Nurse Practitioner 363LF0000X 26NJ00451600 NJ Primary

Addresses

Primary practice location

141 S Black Horse Pike Ste 104
Blackwood, NJ 08012-2958

Mailing address

141 S Black Horse Pike Ste 104
Blackwood, NJ 08012-2958
Phone (856) 292-8216

Other identifiers 1

IdentifierTypeStateIssuer
0393011MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140411000803 NJ Practitioner - Nurse Practitioner 2961577531 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
LG0000584DEMDNurse Practitioner
26NJ00451600NJMDFamily Nurse Practitioner
SP008042PAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Seto Medical Providers,LLC CurrentSince Jan 4, 2014 Accepting new patients

Locations

100 Red Bank Ave
West Deptford, NJ 08096
Phone (856) 241-3311

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426550400000",
    "number": "1902076318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 S BLACK HORSE PIKE STE 104",
            "city": "BLACKWOOD",
            "state": "NJ",
            "postal_code": "080122958",
            "telephone_number": "856-292-8216",
            "fax_number": "856-848-3011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 S BLACK HORSE PIKE STE 104",
            "city": "BLACKWOOD",
            "state": "NJ",
            "postal_code": "080122958",
            "telephone_number": "856-292-8216",
            "fax_number": "856-848-3011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRAIG",
        "first_name": "HOLLY",
        "middle_name": "L.",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-03",
        "last_updated": "2015-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "DE",
            "license": "LG0000584",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP008042",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "DE",
            "license": "LG-0000584",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ00451600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0393011",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blackwood, NJ

Sources for this page

Verify at the official NPI Registry.