Healthcare Provider Details

I. General information

NPI: 1861435455
Provider Name (Legal Business Name): EDITH C KRAMER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 NW STEWART PKWY SUITE 240
ROSEBURG OR
97471-1516
US

IV. Provider business mailing address

PO BOX 568
WINCHESTER OR
97495-0568
US

V. Phone/Fax

Practice location:
  • Phone: 541-677-4427
  • Fax: 541-677-6522
Mailing address:
  • Phone: 541-677-4427
  • Fax: 541-677-6522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number099006554N5
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number099006554N5
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: