Provider Demographics
NPI:1700940400
Name:KRAMER, MARYJO (LPN)
Entity type:Individual
Prefix:
First Name:MARYJO
Middle Name:
Last Name:KRAMER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 N 4TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-1750
Mailing Address - Country:US
Mailing Address - Phone:724-523-6488
Mailing Address - Fax:724-523-6680
Practice Address - Street 1:621 N 4TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-1750
Practice Address - Country:US
Practice Address - Phone:724-523-6488
Practice Address - Fax:724-523-6680
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
PAPN072007L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA78676OtherHEALTH ASSURANCE
PA1045130OtherAETNA HEALTH MANAGEMENT,
PA251783507OtherCIGNA HEALTHCARE
PA2517835070001OtherWPEE INSURANCE
PA000000R598OtherUPMC