Provider Demographics
NPI:1679570923
Name:KRAMERS, SUSANNE THAYER (PA)
Entity type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:THAYER
Last Name:KRAMERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 COLLYER ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1560
Mailing Address - Country:US
Mailing Address - Phone:401-421-4200
Mailing Address - Fax:401-421-4232
Practice Address - Street 1:208 COLLYER ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1560
Practice Address - Country:US
Practice Address - Phone:401-421-4200
Practice Address - Fax:401-421-4232
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00025363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0000000783OtherBKUE CROSS & BLUE SHIELD
RI404576OtherBLUE CHIP
RI7043202Medicaid