Provider Demographics
NPI:1982613345
Name:HARVEY CRAMER, MARILEE KAE (NP)
Entity Type:Individual
Prefix:
First Name:MARILEE
Middle Name:KAE
Last Name:HARVEY CRAMER
Suffix:
Gender:F
Credentials:NP
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 500
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-0500
Mailing Address - Country:US
Mailing Address - Phone:217-670-2424
Mailing Address - Fax:217-670-2809
Practice Address - Street 1:2901 OLD JACKSONVILLE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7437
Practice Address - Country:US
Practice Address - Phone:217-698-9722
Practice Address - Fax:217-391-0392
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041206732363L00000X, 163W00000X
IL209002225164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08421024OtherBC/BS
IL133586700OtherACS-OWCP
IL14D0949277OtherCLIA
IL041206732OtherIL STATE LICENSE
IL500012379OtherRR MEDICARE PIN
ILCD7143OtherRR MEDICARE GROUP
IL064699OtherHEALTH ALLIANCE
IL323742OtherHEALTHLINK
IL020057300OtherBLACK LUNG
IL6394POtherCATERPILLAR
IL209002225OtherIL ADVANCED PRAC NURS LIC
IL14D0949277OtherCLIA