Healthcare Provider Details

I. General information

NPI: 1740103761
Provider Name (Legal Business Name): NATHAN R KREAMER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 E 13TH ST
WINAMAC IN
46996-1117
US

IV. Provider business mailing address

1500 S STATE ROAD 17
KEWANNA IN
46939-9515
US

V. Phone/Fax

Practice location:
  • Phone: 574-946-2100
  • Fax:
Mailing address:
  • Phone: 574-242-0758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1613760
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: