Provider Demographics
NPI:1851311161
Name:STRATE, CHARLOTTE (CRNA)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:STRATE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:HENDRIX
Mailing Address - State:OK
Mailing Address - Zip Code:74741-1920
Mailing Address - Country:US
Mailing Address - Phone:214-458-9164
Mailing Address - Fax:
Practice Address - Street 1:2020 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2291
Practice Address - Country:US
Practice Address - Phone:920-445-7226
Practice Address - Fax:920-445-7239
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218043367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1851311161Medicaid
TX1851311161OtherMEDICARE
TX211050125Medicaid
TX82467UOtherBCBSTX
TX130141808Medicaid
WI211050125OtherMEDICARE
WI211050125Medicaid
TX1851311161Medicaid
TX8705B8Medicare PIN