Provider Demographics
NPI:1710316898
Name:SWANSON-CRAMER, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SWANSON-CRAMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:SWANSON-CRAMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:302 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3220
Mailing Address - Country:US
Mailing Address - Phone:253-770-3589
Mailing Address - Fax:
Practice Address - Street 1:302 2ND ST SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3220
Practice Address - Country:US
Practice Address - Phone:253-770-3589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00049412164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse