Provider Demographics
NPI:1407835903
Name:ZASTROW, CRAIG STEVEN (ANPC)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:STEVEN
Last Name:ZASTROW
Suffix:
Gender:M
Credentials:ANPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-9001
Mailing Address - Country:US
Mailing Address - Phone:715-804-7500
Mailing Address - Fax:
Practice Address - Street 1:3430 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-9001
Practice Address - Country:US
Practice Address - Phone:715-804-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2546033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI101778OtherRN LICENSE
610350023Medicare ID - Type Unspecified
391800026Medicare ID - Type Unspecified
WI41195800Medicaid