Basic Information
Provider Information
NPI: 1902181159
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KRAEMER-COLE
FirstName: ABIGAIL
MiddleName: JANE
NamePrefix: MS.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1400 E. CHURCH STREET
Address2: MEDICAL STAFF OFFICE
City: SANTA MARIA
State: CA
PostalCode: 93454
CountryCode: US
TelephoneNumber: 8057393954
FaxNumber: 8057393060
Practice Location
Address1: 2271 S. DEPOT STREET
Address2:  
City: SANTA MARIA
State: CA
PostalCode: 93455
CountryCode: US
TelephoneNumber: 8059220561
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/19/2011
LastUpdateDate: 01/08/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700X23129CAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


Home