Basic Information
| Provider Information | |||||||||
| NPI: | 1043633167 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRAMER | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | SUZANNE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | BAPTIST WAKE FOREST MEDICAL CTR | ||||||||
| Address2: | MEDICAL CENTER BLVD | ||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271571089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367161896 | ||||||||
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| Practice Location | |||||||||
| Address1: | BAPTIST WAKE FOREST MEDICAL CTR | ||||||||
| Address2: | MEDICAL CENTER BLVD | ||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271571089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367161896 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2014 | ||||||||
| LastUpdateDate: | 03/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | FORS-B7DLQ4 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.