Provider Demographics
NPI:1720779341
Name:STODDARD, CATHERINE ANNA SCARLETT
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANNA SCARLETT
Last Name:STODDARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37767 VIA ROSALIE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-2972
Mailing Address - Country:US
Mailing Address - Phone:716-238-6909
Mailing Address - Fax:
Practice Address - Street 1:2240 N OPDYKE RD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2435
Practice Address - Country:US
Practice Address - Phone:248-289-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIF03230308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily