Provider Demographics
NPI:1801496047
Name:KRAMP, TANNER VAUGHN
Entity type:Individual
Prefix:MR
First Name:TANNER
Middle Name:VAUGHN
Last Name:KRAMP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 WILD TURKEY RD
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-1762
Mailing Address - Country:US
Mailing Address - Phone:651-380-6251
Mailing Address - Fax:
Practice Address - Street 1:3450 WILD TURKEY RD
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-1762
Practice Address - Country:US
Practice Address - Phone:651-380-6251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant