Provider Demographics
NPI:1609461789
Name:CAUDILL, MEREDITH (FNP-C)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 STRATFORD ST
Mailing Address - Street 2:
Mailing Address - City:MONTREAL
Mailing Address - State:WI
Mailing Address - Zip Code:54550-9705
Mailing Address - Country:US
Mailing Address - Phone:906-231-7217
Mailing Address - Fax:
Practice Address - Street 1:N10565 GRANDVIEW LN
Practice Address - Street 2:
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-9622
Practice Address - Country:US
Practice Address - Phone:906-932-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704239677363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner