Provider Demographics
NPI:1922324326
Name:BRAMMER, STEPHANIE MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:BRAMMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 WEST ATEN ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251
Mailing Address - Country:US
Mailing Address - Phone:760-355-8300
Mailing Address - Fax:760-545-0240
Practice Address - Street 1:516 WEST ATEN ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:IMPERIAL
Practice Address - State:CA
Practice Address - Zip Code:92251
Practice Address - Country:US
Practice Address - Phone:760-355-8300
Practice Address - Fax:760-545-0240
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20877363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13536OtherGROUP MEDICARE
CAGR0066313Medicaid
CAPA20877OtherSTATE LICENSE
CAW13536OtherGROUP MEDICARE