Healthcare Provider Details

I. General information

NPI: 1528053691
Provider Name (Legal Business Name): SANDRA L KRAEMER-KEEKER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S LINCOLN RD
ESCANABA MI
49829-1215
US

IV. Provider business mailing address

PO BOX 22487
GREEN BAY WI
54305-2487
US

V. Phone/Fax

Practice location:
  • Phone: 906-786-6488
  • Fax:
Mailing address:
  • Phone: 920-445-7210
  • Fax: 920-445-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601002477
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: