Provider Demographics
NPI:1821074824
Name:STRODTHOFF, CARITAS M (APNP)
Entity Type:Individual
Prefix:
First Name:CARITAS
Middle Name:M
Last Name:STRODTHOFF
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2409 SOUTH ALVERNO ROAD
Mailing Address - Street 2:HOLY FAMILY HEALTH CLINIC
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-9302
Mailing Address - Country:US
Mailing Address - Phone:920-682-7728
Mailing Address - Fax:920-682-4243
Practice Address - Street 1:2409 SOUTH ALVERNO ROAD
Practice Address - Street 2:HOLY FAMILY HEALTH CLINIC
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-9302
Practice Address - Country:US
Practice Address - Phone:920-682-7728
Practice Address - Fax:920-682-4243
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI607 033363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000Medicare UPIN