Provider Demographics
NPI:1336716976
Name:KRAMER, JESSICA (LAC, LMT, RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KRAMER
Suffix:
Gender:F
Credentials:LAC, LMT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:SPRING GREEN
Mailing Address - State:WI
Mailing Address - Zip Code:53588-0305
Mailing Address - Country:US
Mailing Address - Phone:608-475-3175
Mailing Address - Fax:
Practice Address - Street 1:132 N ALBANY STREET
Practice Address - Street 2:
Practice Address - City:SPRING GREEN
Practice Address - State:WI
Practice Address - Zip Code:53588
Practice Address - Country:US
Practice Address - Phone:608-475-3175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI712-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist