Provider Demographics
NPI:1861505794
Name:STRAUSS-HODER, TINA (CNP)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:STRAUSS-HODER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MRS
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:STRAUSS-HODER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1616 SHERIDAN RD
Mailing Address - Street 2:9A
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1875
Mailing Address - Country:US
Mailing Address - Phone:847-251-5337
Mailing Address - Fax:
Practice Address - Street 1:1616 SHERIDAN RD
Practice Address - Street 2:9A
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1875
Practice Address - Country:US
Practice Address - Phone:847-251-5337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P91313Medicare UPIN
K09801Medicare ID - Type Unspecified