Healthcare Provider Details

I. General information

NPI: 1598814618
Provider Name (Legal Business Name): THOMAS CRAMER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 N WEST ST
PERRYVILLE MO
63775-1359
US

IV. Provider business mailing address

PO BOX 486
STE GENEVIEVE MO
63670-0486
US

V. Phone/Fax

Practice location:
  • Phone: 573-547-2536
  • Fax:
Mailing address:
  • Phone: 573-883-2751
  • Fax: 573-883-4472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number081104
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: