Provider Demographics
NPI:1770947335
Name:KRAMER, JUDITH ANN
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:KRAMER
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 1:15842 COBBLESTONE LAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7863
Mailing Address - Country:US
Mailing Address - Phone:651-402-6300
Mailing Address - Fax:651-688-9228
Practice Address - Street 1:15842 COBBLESTONE LAKE PKWY
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7863
Practice Address - Country:US
Practice Address - Phone:651-402-6300
Practice Address - Fax:651-688-9228
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32207172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker