Provider Demographics
NPI:1487242533
Name:EMERSON, CRAIG
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:EMERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:TOWNER
Mailing Address - State:ND
Mailing Address - Zip Code:58788-0133
Mailing Address - Country:US
Mailing Address - Phone:406-478-1399
Mailing Address - Fax:
Practice Address - Street 1:406 2ND ST SW
Practice Address - Street 2:
Practice Address - City:TOWNER
Practice Address - State:ND
Practice Address - Zip Code:58788-5878
Practice Address - Country:US
Practice Address - Phone:406-478-1399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0107519734109172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver