MEDICARE: CATHERINE ANNA SCARLETT STODDARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F03230308	MI

General Provider Information

NPI Number	:	1720779341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE ANNA SCARLETT STODDARD

Provider Business Mailing Address
First Line	:	37767 VIA ROSALIE ST
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48036-2972
Country	:	US
Telephone Number	:	716-238-6909
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 N OPDYKE RD
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-2435
Country	:	US
Telephone Number	:	248-289-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2023
Last Update Date	:	05/17/2023

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