Provider Demographics
NPI:1922366749
Name:CRAMM, KELLIE LYNN
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:LYNN
Last Name:CRAMM
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KELLIE
Other - Middle Name:CRAMM
Other - Last Name:KIRBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2418 WASHINGTON ST
Mailing Address - Street 2:APT 1
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1867
Mailing Address - Country:US
Mailing Address - Phone:949-338-7574
Mailing Address - Fax:
Practice Address - Street 1:2418 WASHINGTON ST
Practice Address - Street 2:APT 1
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1867
Practice Address - Country:US
Practice Address - Phone:949-338-7574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program