Provider Demographics
NPI:1134322746
Name:KRAMER, KAY A IV (LMP)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:A
Last Name:KRAMER
Suffix:IV
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 110TH DR SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98205-2526
Mailing Address - Country:US
Mailing Address - Phone:425-334-2307
Mailing Address - Fax:
Practice Address - Street 1:127 AVENUE C
Practice Address - Street 2:SUITE A
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2768
Practice Address - Country:US
Practice Address - Phone:360-568-4185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010634174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0124385OtherL & I PROVIDER
WA3786KROtherREGENCE PROVIDER