Provider Demographics
NPI:1972788008
Name:STRATER, CARLA SUE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:SUE
Last Name:STRATER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21075 STATE ROUTE 47
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45340-8724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1155 N 1200 W
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540-9372
Practice Address - Country:US
Practice Address - Phone:574-825-3888
Practice Address - Fax:574-825-3999
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA-07418-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000577053OtherANTHEM BCBS OH
OH2826937Medicaid
OHSTNP26881Medicare PIN