Basic Information
| Provider Information | |||||||||
| NPI: | 1831607373 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STROM | ||||||||
| FirstName: | CAROLYNN | ||||||||
| MiddleName: | SUZANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3496 NW FEDERAL HWY STE F | ||||||||
| Address2: | |||||||||
| City: | JENSEN BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349574441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722235945 | ||||||||
| FaxNumber: | 7722232887 | ||||||||
| Practice Location | |||||||||
| Address1: | 3496 NW FEDERAL HWY STE F | ||||||||
| Address2: | |||||||||
| City: | JENSEN BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349574441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722235945 | ||||||||
| FaxNumber: | 7722232887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2018 | ||||||||
| LastUpdateDate: | 01/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WD0400X | 9317201 | FL | Y | Nursing Service Providers | Registered Nurse | Diabetes Educator |
ID Information
| ID | Type | State | Issuer | Description | 21310376 | 01 | CERTIFIED DIABETES EDUCATOR | OTHER | RN9317201 | 01 | FL | REGISTERED NURSE | OTHER |