Provider Demographics
NPI:1649557489
Name:STODOLA, KATHERINE ANDRIES (APNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANDRIES
Last Name:STODOLA
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANDRIES
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2917 INTERNATIONAL LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3135
Mailing Address - Country:US
Mailing Address - Phone:608-240-0020
Mailing Address - Fax:608-246-8428
Practice Address - Street 1:2425 NEW PINERY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-1300
Practice Address - Country:US
Practice Address - Phone:608-742-8900
Practice Address - Fax:866-561-2682
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI148406-30163W00000X
WI4693-33363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse