Basic Information
Provider Information
NPI: 1205811387
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KREMER
FirstName: CARRIE
MiddleName: J
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8170 33RD AVE S
Address2: MS 21110Q
City: BLOOMINGTON
State: MN
PostalCode: 554254516
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 8600 NICOLLET AVE S
Address2:  
City: BLOOMINGTON
State: MN
PostalCode: 554202824
CountryCode: US
TelephoneNumber: 9525412800
FaxNumber: 9528867015
Other Information
ProviderEnumerationDate: 12/12/2005
LastUpdateDate: 03/17/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/17/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X46471MNY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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