Healthcare Provider Details

I. General information

NPI: 1992283055
Provider Name (Legal Business Name): RAENETTE MARIE KRAMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N MAIN ST
SUNDERLAND MA
01375-9502
US

IV. Provider business mailing address

359 PARTRIDGEVILLE RD
ATHOL MA
01331-9617
US

V. Phone/Fax

Practice location:
  • Phone: 413-665-8717
  • Fax:
Mailing address:
  • Phone: 508-363-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number195532
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: