Provider Demographics
NPI:1174679542
Name:CRAMER, CAROL (LMP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:CRAMER
Suffix:
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 1:22002 64TH AVE W
Mailing Address - Street 2:SUITE M 8
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2528
Mailing Address - Country:US
Mailing Address - Phone:206-650-3361
Mailing Address - Fax:
Practice Address - Street 1:22002 64TH AVE W
Practice Address - Street 2:SUITE M 8
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2528
Practice Address - Country:US
Practice Address - Phone:206-650-3361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA9532174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist