Individual
CHARLES R NORDSTROM JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
127 CANTERBURY RD, EAU CLAIRE, WI 54701-7105
(715) 835-1884
Mailing address
127 CANTERBURY RD, EAU CLAIRE, WI 54701-7105
(715) 835-1884
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
21796
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30184300
—
WI
Enumeration date
02/07/2006
Last updated
01/31/2012
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