Provider Demographics
NPI:1326202847
Name:KRAMER, STACY L (APN-BC)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:L
Last Name:KRAMER
Suffix:
Gender:F
Credentials:APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5995 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5028
Mailing Address - Country:US
Mailing Address - Phone:602-908-7273
Mailing Address - Fax:855-251-9774
Practice Address - Street 1:5995 PLAZA DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5028
Practice Address - Country:US
Practice Address - Phone:602-908-7273
Practice Address - Fax:855-251-9774
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-005551363LG0600X
CA95000016363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0727500001Medicare NSC