Healthcare Provider Details

I. General information

NPI: 1396103974
Provider Name (Legal Business Name): TERESA CRAMER-MCDONALD NP,APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N9512 HWY 33
FOX LAKE WI
53933-9442
US

IV. Provider business mailing address

N9512 HWY 33
FOX LAKE WI
53933-9442
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number79439-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: