Provider Demographics
NPI:1760918593
Name:KRAEMER, SIOBHAN
Entity Type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:
Last Name:KRAEMER
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 1:433 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-2930
Mailing Address - Country:US
Mailing Address - Phone:551-265-7538
Mailing Address - Fax:
Practice Address - Street 1:433 4TH AVE
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-2930
Practice Address - Country:US
Practice Address - Phone:551-265-7538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2022-10-13
Deactivation Date:2018-09-15
Deactivation Code:
Reactivation Date:2022-10-13
Provider Licenses
StateLicense IDTaxonomies
NY293146164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse