Individual
TARAH ELISSA CRANICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 457-0469
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003209
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3932056
BLUE SHIELD
IL
Enumeration date
10/13/2006
Last updated
12/02/2021
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