Basic Information
| Provider Information | |||||||||
| NPI: | 1356307466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRAMER | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | DEE | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10 | ||||||||
| Address2: | 800 OAK STREET | ||||||||
| City: | SHELDON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 512010010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123245356 | ||||||||
| FaxNumber: | 7123246515 | ||||||||
| Practice Location | |||||||||
| Address1: | 321 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SANBORN | ||||||||
| State: | IA | ||||||||
| PostalCode: | 512487731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7127293545 | ||||||||
| FaxNumber: | 7127295767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 04/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 067675 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 21118 | 01 | IA | SIOUX VALLEY HEALTHPLAN | OTHER |