Provider Demographics
NPI:1063687788
Name:KRAMER, NICHOLE G (MEDICAL AESTHETICIAN)
Entity Type:Individual
Prefix:MS
First Name:NICHOLE
Middle Name:G
Last Name:KRAMER
Suffix:
Gender:F
Credentials:MEDICAL AESTHETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF UTAH PLASTIC SURGERY
Mailing Address - Street 2:50 N MEDICAL DRIVE
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-581-4322
Mailing Address - Fax:801-581-5794
Practice Address - Street 1:UNIVERSITY OF UTAH PLASTIC SURGERY
Practice Address - Street 2:50 N MEDICAL DRIVE
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-4322
Practice Address - Fax:801-581-5794
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist