Healthcare Provider Details

I. General information

NPI: 1205294287
Provider Name (Legal Business Name): BRENDA KRAMER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 S 5TH ST BOX 4010
ODESSA DE
19730-2078
US

IV. Provider business mailing address

313 S 5TH ST BOX 4010
ODESSA DE
19730-2078
US

V. Phone/Fax

Practice location:
  • Phone: 302-376-4128
  • Fax:
Mailing address:
  • Phone: 302-376-4128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0038834
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: