Provider Demographics
NPI:1972560464
Name:KRAUTKRAMER, SUSAN R (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:KRAUTKRAMER
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 1:1017 W 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:WRAY
Mailing Address - State:CO
Mailing Address - Zip Code:80758-1420
Mailing Address - Country:US
Mailing Address - Phone:970-332-4895
Mailing Address - Fax:970-332-4665
Practice Address - Street 1:1017 W 7TH ST
Practice Address - Street 2:
Practice Address - City:WRAY
Practice Address - State:CO
Practice Address - Zip Code:80758-1420
Practice Address - Country:US
Practice Address - Phone:970-332-4895
Practice Address - Fax:970-332-4665
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1319363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05576814Medicaid