Provider Demographics
NPI:1659905750
Name:KREIMER, NICOLE (ATC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:KREIMER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-2607
Mailing Address - Country:US
Mailing Address - Phone:443-605-2785
Mailing Address - Fax:
Practice Address - Street 1:12630 BROADFORDING RD
Practice Address - Street 2:
Practice Address - City:CLEAR SPRING
Practice Address - State:MD
Practice Address - Zip Code:21722-1363
Practice Address - Country:US
Practice Address - Phone:443-605-2785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0001328207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine