Provider Demographics
NPI:1861435455
Name:KRAMER, EDITH C (CNM)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:C
Last Name:KRAMER
Suffix:
Gender:F
Credentials:CNM
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 568
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:OR
Mailing Address - Zip Code:97495-0568
Mailing Address - Country:US
Mailing Address - Phone:541-677-4427
Mailing Address - Fax:541-677-6522
Practice Address - Street 1:2460 NW STEWART PKWY
Practice Address - Street 2:SUITE 240
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1516
Practice Address - Country:US
Practice Address - Phone:541-677-4427
Practice Address - Fax:541-677-6522
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR099006554N5363LX0001X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR210768Medicaid
OR210768Medicaid
ORR113595Medicare PIN