Provider Demographics
NPI:1568520146
Name:REEDY STROUS, THERESA M (APNP)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:M
Last Name:REEDY STROUS
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 E GRANT ST
Mailing Address - Street 2:SUITE S250
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911
Mailing Address - Country:US
Mailing Address - Phone:920-734-9600
Mailing Address - Fax:920-734-4773
Practice Address - Street 1:130 2ND ST
Practice Address - Street 2:SUITE N410
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2883
Practice Address - Country:US
Practice Address - Phone:920-729-0608
Practice Address - Fax:920-720-2902
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1720033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43919600Medicaid
WI43919600Medicaid