Provider Demographics
NPI:1679789184
Name:CRAMER, HIDI MICKELSON (LAC, LMP)
Entity Type:Individual
Prefix:MS
First Name:HIDI
Middle Name:MICKELSON
Last Name:CRAMER
Suffix:
Gender:F
Credentials:LAC, LMP
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 98845
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-0845
Mailing Address - Country:US
Mailing Address - Phone:206-824-0809
Mailing Address - Fax:206-824-0795
Practice Address - Street 1:22525 MARINE VIEW DR S
Practice Address - Street 2:SUITE 100
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6831
Practice Address - Country:US
Practice Address - Phone:206-824-0809
Practice Address - Fax:206-824-0795
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000406171100000X
WAMA00008972174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered174400000XOther Service ProvidersSpecialist