Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | FORS-B7DLQ4 | NC |
NPI | 1043633167 |
---|---|
Provider Name | Mary Suzanne Cramer |
First Address | Winston Salem, NC 27157-1089 |
Second Address | Winston Salem, NC 27157-1089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2014 |
Last Update Date | 30/03/2015 |