Provider Demographics
NPI:1366483620
Name:CRAMER, MELINDA (ACNP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:CRAMER
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70434-2379
Mailing Address - Country:US
Mailing Address - Phone:985-871-6020
Mailing Address - Fax:985-871-6027
Practice Address - Street 1:1203 S TYLER ST
Practice Address - Street 2:STE E
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2329
Practice Address - Country:US
Practice Address - Phone:985-871-6020
Practice Address - Fax:985-871-6027
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04464363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1465208Medicaid
LA1465208Medicaid
LA4H228Medicare ID - Type Unspecified