Provider Demographics
NPI:1487183067
Name:STRODER, KEITH LAMAR (CNP)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:LAMAR
Last Name:STRODER
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4423 COPPER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-7024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6855 SPRING VALLEY DR STE 150
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-7012
Practice Address - Country:US
Practice Address - Phone:419-724-0004
Practice Address - Fax:888-677-1987
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020866363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily