Provider Demographics
NPI:1942300835
Name:STRATTON, CHARLYN E (NP)
Entity Type:Individual
Prefix:
First Name:CHARLYN
Middle Name:E
Last Name:STRATTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W SAGINAW ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48915-1925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 W SAGINAW ST
Practice Address - Street 2:SUITE 500
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-1925
Practice Address - Country:US
Practice Address - Phone:517-364-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI470469546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI773293499Medicaid
MI773293499Medicaid
MIS74512Medicare UPIN