Provider Demographics
NPI:1639276702
Name:CRAMER, CINNAMON TRAVIS (CPNP)
Entity Type:Individual
Prefix:
First Name:CINNAMON
Middle Name:TRAVIS
Last Name:CRAMER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 E CAPITOL ST
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-2218
Mailing Address - Country:US
Mailing Address - Phone:334-289-9408
Mailing Address - Fax:334-289-1160
Practice Address - Street 1:123 E CAPITOL ST
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-2218
Practice Address - Country:US
Practice Address - Phone:334-289-9408
Practice Address - Fax:334-289-1160
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-072359363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL631022584Medicaid