Provider Demographics
NPI:1669030789
Name:STROH, CHRISTOPHER DERRICK (CRNA)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DERRICK
Last Name:STROH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 EDGEWAY DR APT 601
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-4257
Mailing Address - Country:US
Mailing Address - Phone:513-205-6417
Mailing Address - Fax:
Practice Address - Street 1:191 EDGEWAY DR APT 601
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4257
Practice Address - Country:US
Practice Address - Phone:513-205-6417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC297829163W00000X
TXAP143320367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse