Provider Demographics
NPI:1972100097
Name:KRAEMER, DEANNA (FNP)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:KRAEMER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 N 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-6541
Mailing Address - Country:US
Mailing Address - Phone:844-900-2567
Mailing Address - Fax:602-609-4349
Practice Address - Street 1:5104 N 67TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-6541
Practice Address - Country:US
Practice Address - Phone:844-900-2567
Practice Address - Fax:602-609-4349
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ248196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ248824OtherMEDICARE PTAN
AZZ248825OtherMEDICARE PTAN