Provider Demographics
NPI:1447912092
Name:KRAEMER, JACOB ALLEN
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:ALLEN
Last Name:KRAEMER
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 1:1324 DILL PARK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:PA
Mailing Address - Zip Code:16428-3228
Mailing Address - Country:US
Mailing Address - Phone:814-882-5256
Mailing Address - Fax:
Practice Address - Street 1:1324 DILL PARK RD
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:PA
Practice Address - Zip Code:16428-3228
Practice Address - Country:US
Practice Address - Phone:814-882-5256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program