Healthcare Provider Details

I. General information

NPI: 1609461789
Provider Name (Legal Business Name): MEREDITH CAUDILL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N10565 GRANDVIEW LN
IRONWOOD MI
49938-9622
US

IV. Provider business mailing address

7 STRATFORD ST
MONTREAL WI
54550-9705
US

V. Phone/Fax

Practice location:
  • Phone: 906-932-1500
  • Fax:
Mailing address:
  • Phone: 906-231-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704239677
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: