Provider Demographics
NPI:1669686192
Name:KRAMER, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KRAMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 HIGHLAND LN
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-7049
Mailing Address - Country:US
Mailing Address - Phone:937-467-9047
Mailing Address - Fax:
Practice Address - Street 1:1430 HIGHLAND LN
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-7049
Practice Address - Country:US
Practice Address - Phone:937-467-9047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH105901329099Medicaid
OH106149317599Medicaid