Individual
MR. KYOUNG CRADDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5722 65TH ST NE, MARYSVILLE, WA 98270
(253) 590-6817
Mailing address
5722 65TH ST NE, MARYSVILLE, WA 98270
(253) 590-6817
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN60221376
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
163W00000X
NURSING SERVICE PROVIDERS, REGISTERED NURSE (NURSE DELEGATION)
WA
Enumeration date
06/02/2016
Last updated
06/02/2016
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