Provider Demographics
NPI:1285839399
Name:KRAMER, SHANTRELL M (NP)
Entity Type:Individual
Prefix:
First Name:SHANTRELL
Middle Name:M
Last Name:KRAMER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19415 DEERFIELD AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8452
Mailing Address - Country:US
Mailing Address - Phone:703-729-6030
Mailing Address - Fax:703-729-1446
Practice Address - Street 1:19415 DEERFIELD AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8452
Practice Address - Country:US
Practice Address - Phone:703-729-6030
Practice Address - Fax:703-729-1446
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166378363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187159201Medicaid
TX187159203Medicaid
TX187159202Medicaid
TX8J8906Medicare PIN
TX8J8908Medicare PIN
TX187159202Medicaid
VAQ41674Medicare UPIN