MEDICARE: MS. TERESA JEAN CRAMER CPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife

General Provider Information

NPI Number	:	1043636707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERESA JEAN CRAMER CPM

Provider Business Mailing Address
First Line	:	641 SPENCER ST NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-5207
Country	:	US
Telephone Number	:	616-334-2326
Fax Number	:

Provider Business Practice Location Address
First Line	:	641 SPENCER ST NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-5207
Country	:	US
Telephone Number	:	616-334-2326
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2014
Last Update Date	:	09/09/2016

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